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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304310494
Report Date: 03/06/2025
Date Signed: 03/06/2025 04:28:36 PM

Document Has Been Signed on 03/06/2025 04:28 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:ALVARADO-LANDAVERDE, MIRNAFACILITY NUMBER:
304310494
ADMINISTRATOR/
DIRECTOR:		ALVARADO-LANDAVERDE, MIRNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 262-3738
CITY:ANAHEIMSTATE: CAZIP CODE:
92806
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
03/06/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:40 PM
MET WITH:Assistant Perla GomezTIME VISIT/
INSPECTION COMPLETED:
04:40 PM
NARRATIVE
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(Page 1)
An Annual Random inspection was conducted at the facility by Licensing Program Analyst (LPA) Giselle Lucero. At 12:40 AM, Assistant Perla Gomez allowed LPA entry into the facility, Assistant stated Licensee was laying down in a bedroom but that she will notify licensee regarding LPA's visit. Upon entrance of the facility, LPA observed 8 preschool children sleeping in the second living room (childcare room), dining room and kitchen area. Upon taking census, LPA confirmed with the 2nd assistant, Ana Barradas, if there were any other children in the home. Assistant informed LPA there are 2 infants sleeping in a bedroom (next to childcare room) and 1 other infant sleeping in another bedroom. Licensee than greeted LPA with Child #1 (C1) in her arms. LPA observed C1 with sleepy eyes as if C1 was just woken up. LPA asked Licensee where C1 was sleeping, and Licensee stated C1 was sleeping in the bedroom. LPA asked for licensee to show LPA the bedroom where C1 was sleeping. LPA observed the bedroom did not have a crib or play yard, but did observe 2 strollers. LPA asked Licensee where C1 was sleeping, and licensee stated C1 was sleeping in the stroller. LPA observed the stroller C1 was sleeping on had toys attached by a string. LPA observed an unoccupied play yard in the dining room to have infant’s play equipment stored inside play yard. LPA inquired with Licensee why C1 was not placed in the unoccupied play yard, Licensee stated C1 does not like to sleep in the play yard and earlier in the day they were outside playing and C1 was in the stroller, C1 than fell asleep and when they came back inside, C1 was still sleeping in the stroller. Licensee stated she does not allow infants to sleep for a long time in the strollers. Based on interview, C1 was sleeping in the stroller for approximately 20 minutes. LPA then entered the other bedroom where the 2 infants were sleeping, and observed the infants had blankets in their cribs. LPA immediately addressed deficiency in accordance with regulations and Licensee immediately removed blankets from cribs. LPA observed licensee and 2 assistants caring for 11 children which included 4 infants and 8 preschool age children napping in the living room and bedroom. Licensee was operating within the licensed capacity as specified on license.

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SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Giselle Lucero
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: ALVARADO-LANDAVERDE, MIRNA
FACILITY NUMBER: 304310494
VISIT DATE: 03/06/2025
NARRATIVE
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(Page 2)
A review of the Facility Personnel Report Summary on this date indicates all facility residents, staff, or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Currently the licensee is the only adult living in the facility. Facility Day care hours are 7am-5pm, Monday through Friday.

During today’s inspection, LPA and licensee toured the inside and outside areas identified in the facility sketch as accessible to childcare children. Off limits areas are made inaccessible by means of child proof doorknobs and locked doors. The childcare area consists of the second living room (child care room), dining room, kitchen, one bedroom (located next to the kitchen) and a second bedroom (located in the hallway). The children walk through the laundry room to the bathroom. Licensee stated the children's primary area is the second living room (child care room). There are working carbon monoxide, smoke detector, and fire extinguishers in the home that meet statutory and State Fire Marshall standards. Detergents, cleaning compounds, medicines, and other items which could pose a danger if readily available to children were stored inaccessible to children. There were no poisons or other items observed which could pose a danger to children or if they were observed, they were locked or inaccessible. Licensee stated there are no firearms and/or other dangerous weapons in the facility and none were observed during today's inspections. There is a fireplace in between the second living room and dining room screened by an iron gate and inaccessible to children in care. The home has age appropriate toys for the ages served. LPA verified there is a working telephone service (cellular service), licensee was reminded that childcare phone needs to remain the in the childcare at all times. Licensee stated they use the backyard for outdoor play. There are no bodies of water on the premises.

The licensee does have a current roster of children in care. A sample of 5 Children’s records for children present during LPA’s inspection were reviewed for a copy of the emergency information card that contains all the information specified by regulation (LIC 700), Immunization records, Affidavit Regarding Liability Insurance (LIC282), Consent for Emergency Medical Treatment (LIC627), Notification of Parent’s Rights (LIC995A) and found to be in compliance. Licensee stated, there are 4 infants under 24 months enrolled in the childcare. During record review, LPA observed 4 out of 4 infants did not have an Individual Infant Sleeping Plan (LIC 9227) in their file. LPA reviewed napping log for infants.
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SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Giselle Lucero
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: ALVARADO-LANDAVERDE, MIRNA
FACILITY NUMBER: 304310494
VISIT DATE: 03/06/2025
NARRATIVE
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(page 3)
The licensee’s Pediatric CPR/First Aid certification expires 06/08/2026. Beginning September 1, 2016, Health and Safety (H&S) 1597.622 states, a person shall not be employed or volunteer at a family childcare home if he or she has not been immunized against influenza, pertussis, and measles. Proof of immunization against pertussis, measles for licensee and assistants were reviewed. During record review and interview with the licensee, 2 out of 2 staff did not have immunization records against pertussis, and measles in their files.

Beginning March 31, 2018, H&S Code 1596.8662 requires all licensed providers and employees to complete mandated reporting training, and to renew the training every two years.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

Therefore, in the areas that were inspected, 1 Type A and 3 Type B deficiencies were observed of the California Code of Regulations, Title 22, Division 12 at the time of the visit. Type A: Infant Safe Sleep 102425(b), Type B: Infant Safe Sleep 102425(i), Type B: HSC- General Provision and Definitions 1597.622(a)(1), and Type B: Infant Safe Sleep 102425(c). See attached LIC 809D.

LPA Lucero informed Licensee that this report dated 03/06/2025, documents 1 Type A citation which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Lucero informed facility representative to provide a copy of this licensing report dated 03/06/2025 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.
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SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Giselle Lucero
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025
LIC809 (FAS) - (06/04)
Page: 3 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: ALVARADO-LANDAVERDE, MIRNA
FACILITY NUMBER: 304310494
VISIT DATE: 03/06/2025
NARRATIVE
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(page 4)
Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

The licensee understands she must be present in the facility and must ensure children in care are always supervised. Children are not to be left alone in parked vehicles. When the licensee is temporarily absent from the facility, arrangements must be made for a qualified substitute adult to care and supervise children while absent. The substitute adult must have the required criminal record, child abuse index clearances, immunizations, Pediatric CPR/First Aid, and mandated reporter training. LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian

CCLD website www.cdss.ca.gov/inforesources/community-care-licensing was provided to licensee to access regulations, updates, and licensing forms. Licensee was advised to register through childcareadvocatesprogram@dss.ca.gov in order to receive quarterly updates. Licensee was advised of their responsibility to review the Provider Information Notices (PIN) found on the CCLD website..

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.
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SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Giselle Lucero
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025
LIC809 (FAS) - (06/04)
Page: 4 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: ALVARADO-LANDAVERDE, MIRNA
FACILITY NUMBER: 304310494
VISIT DATE: 03/06/2025
NARRATIVE
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(page 5)
To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at
www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Exit interview conducted and report was reviewed with the licensee Mirna Alvarado. A notice of site visit was posted and must remain posted for 30 days.

During the exit interview, the licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

End of Report.
SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Giselle Lucero
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025
LIC809 (FAS) - (06/04)
Page: 5 of 8
Document Has Been Signed on 03/06/2025 04:28 PM - It Cannot Be Edited


Created By: Giselle Lucero On 03/06/2025 at 03:16 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: ALVARADO-LANDAVERDE, MIRNA
FACILITY NUMBER: 304310494

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/06/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102425(b)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and record review, the licensee did not comply with the section cited above. 2 out of 2 infants who were sleeping had blankets in their crib. This poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 03/06/2025
Plan of Correction
1
2
3
4
Licensee immediately removed blankets from crib. Licensee stated she will no longer place blankets in the cribs and if the children are cold, she will turn up the heater.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
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2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Martha Malane
LICENSING EVALUATOR NAME:Giselle Lucero
LICENSING EVALUATOR SIGNATURE:
DATE: 03/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/06/2025


LIC809 (FAS) - (06/04)
Page: 6 of 8
Document Has Been Signed on 03/06/2025 04:28 PM - It Cannot Be Edited


Created By: Giselle Lucero On 03/06/2025 at 03:16 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: ALVARADO-LANDAVERDE, MIRNA
FACILITY NUMBER: 304310494

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/06/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(i)
Infant Safe Sleep
If an infant falls asleep before being placed in a crib or play yard, the provider shall move the infant to a crib or play yard as soon as possible.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and interviews, the licensee did not comply with the section cited above. Child #1 was sleeping in the stroller for approximately 20 minutes. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/06/2025
Plan of Correction
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2
3
4
Licensee stated infants that fall asleep in strollers will be moved to a crib/play yard immediately.
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview and record review, the licensee did not comply with the section cited above. 2 out of 3 staff did not have immunization records in their file. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/14/2025
Plan of Correction
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2
3
4
Licensee stated she will send copies of immunization records for staff to LPA by POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Martha Malane
LICENSING EVALUATOR NAME:Giselle Lucero
LICENSING EVALUATOR SIGNATURE:
DATE: 03/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/06/2025


LIC809 (FAS) - (06/04)
Page: 7 of 8
Document Has Been Signed on 03/06/2025 04:28 PM - It Cannot Be Edited


Created By: Giselle Lucero On 03/06/2025 at 03:16 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: ALVARADO-LANDAVERDE, MIRNA
FACILITY NUMBER: 304310494

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/06/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above. 4 out of 4 infants did not have an Individual Infant Sleeping Plan (LIC 9227) in their files. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/14/2025
Plan of Correction
1
2
3
4
Licensee stated she will send a copy of the LIC 9227 for 2 out of 4 infants who are currently under 1 year old and from now on will provide the LIC 9227 form for infants under 1 year old during enrollment.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Martha Malane
LICENSING EVALUATOR NAME:Giselle Lucero
LICENSING EVALUATOR SIGNATURE:
DATE: 03/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/06/2025


LIC809 (FAS) - (06/04)
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