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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376628105
Report Date: 09/14/2021
Date Signed: 09/14/2021 04:42:29 PM

Document Has Been Signed on 09/14/2021 04:42 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
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:MEZA, YRMA FAMILY CHILD CAREFACILITY NUMBER:
376628105
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 3DATE:
09/14/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Yrma Meza TIME COMPLETED:
04:10 PM
NARRATIVE
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On September 14, 2020, at 1:30 p.m., Licensing Program Analysts (LPA), Casey Gulley and Cindy Meier conducted an unannounced Annual Required Inspection and met with the Licensee, Yrma Meza. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Licensee. Three (3) children and one (1) staff were present in the facility during this inspection. This facility is a two story, four bedroom, three bathroom house. Licensee accompanied LPA inside and out of the facility during this inspection. The following areas used for child care are: living room . Off limits areas are kitchen and bedrooms and were accessible to children in care.

The smoke detector, and carbon monoxide detector did not met requirements. All hazardous items were not inaccessible to children. The licensee has toys, play equipment and materials available. The home has a fenced frontyard available for outdoor activities. No bodies of water observed on the premises during the inspection. Licensee stated there are no weapons in the home. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Licensee’s does not have First Aid and CPR certificate for verification.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Casey Gulley
LICENSING EVALUATOR SIGNATURE: DATE: 09/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/14/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: MEZA, YRMA FAMILY CHILD CARE
FACILITY NUMBER: 376628105
VISIT DATE: 09/14/2021
NARRATIVE
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Licensee has required immunizations. Licensee does not have Mandated Reporter Training certificate Facility roster was not available for reviewed. The last fire and disaster drills were conducted and documented on 03/21. There is one crib or play yard for each infant who is unable to climb out of the crib or play yard. Cribs or play yards are free from all loose articles and objects. The provider does not physically checks on sleeping infants every 15 minutes. An Individual Infant Sleeping Plan [LIC 9227 (3/20)] is not maintained for each infant up to 12 months of age. The provider places infants up to 12 months of age on their backs for sleeping.

children’s records according to regulation, post all required forms, and ensure that all adults residing or working in the home have criminal background clearances or exemptions. Licensee was reminded that corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers and/or similar equipment are not allowed in daycare. Licensee was also provided handouts with information regarding upcoming Safe Sleep Regulations/SIDS, Lead exposure and Shaken Baby Syndrome. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov.

LPA discussed and provided Licensee with the following: child care advocates email address: childcareadvocatesprogram@dss.ca.gov . In addition, for general questions or questions regarding licensing requirements contact the Child Care Licensing Duty Line at (619) 767-2248.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Casey Gulley
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2021
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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
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: MEZA, YRMA FAMILY CHILD CARE
FACILITY NUMBER: 376628105
VISIT DATE: 09/14/2021
NARRATIVE
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Incidental Medical services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm.

California Code of Regulations, (Title 22, Division 12 & Chapter 3), are being cited on the attached LIC 809-D.

Upon Receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

An exit interview was conducted with the licensee. The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights.

LPA provided notice of site visit and observed it being posted at the facility. Notice of Site Visit to be posted for 30 days.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Casey Gulley
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2021
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/14/2021 04:42 PM - It Cannot Be Edited


Created By: Casey Gulley On 09/14/2021 at 02:07 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
, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: MEZA, YRMA FAMILY CHILD CARE
FACILITY NUMBER: 376628105

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/14/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/17/2021
Section Cited
CCR
102417(g)(4)

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102417(g)(4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.
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Licencee stated that a checklist will be created to ensure. Licensee stated that the checklist will be checked in the prior to children arriving.
Licensee stated that a checklist will submitted for review no later than October 14, 2021.
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This requirement was not met as evidenced by LPAs observation.
- chemicals & cleaning compounds were accessible to children via storage in unlatched kitchen, bathroom cabinets stairs near play area and outdoor.
- kitchen knives were accessible to children in unlatched kitchen drawer.
- propane tank and cleaning compound located in outdoor play area.
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Type B
10/14/2021
Section Cited
HSC1596.866(2)(A)(B)

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1596.866(2)(A)(B) Additional health and safety training; condition of licensure – “… each family day care home licensee who provides care, shall have … training … shall include … Pediatric first aid … Pediatric cardiopulmonary resuscitation (CPR).” This requirement is not met as
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Licencee stated an appointment will scheduled as soon a possible. Licensee stated verification of enrollment will be submitted no later than October 14, 2021.
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evidenced by: The Licensee was unable to locate her First Aide/CPR card. Based on LPA’s observation, the Licensee did not ensure current possession of a current First Aide/CPR card, which poses as a potential risk to children in care.
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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:Jason Garay
LICENSING EVALUATOR NAME:Casey Gulley
LICENSING EVALUATOR SIGNATURE:
DATE: 09/14/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/14/2021


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Document Has Been Signed on 09/14/2021 04:42 PM - It Cannot Be Edited


Created By: Casey Gulley On 09/14/2021 at 02:37 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
, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: MEZA, YRMA FAMILY CHILD CARE
FACILITY NUMBER: 376628105

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/14/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/24/2021
Section Cited
CCR
102417(g)(3)

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Operation of a Family Child Care Home. Where children are less than five years old are in care, stairs shall be fenced or barricaded. this was not as evidenced by; upon LPA's arrival at the home, LPA observed stairs not barricaded. There are three children present that are less than 5-years-old.
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Licensee stated that that a new gate will be installed no later than September 20, 2021. Licensee stated pictures will be submitted for verification.
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 This poses a Potential Health and Safety risk to the clients in care.
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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:Jason Garay
LICENSING EVALUATOR NAME:Casey Gulley
LICENSING EVALUATOR SIGNATURE:
DATE: 09/14/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/14/2021


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Document Has Been Signed on 09/14/2021 04:42 PM - It Cannot Be Edited


Created By: Casey Gulley On 09/14/2021 at 02:50 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
, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: MEZA, YRMA FAMILY CHILD CARE
FACILITY NUMBER: 376628105

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/14/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/14/2021
Section Cited
HSC
1596.8662(4)(b)(1)

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1596.8662(4)(b)(1) Mandated Reporter Training On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider,...shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement was not met as evidenced by:
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Licensee stated the class will be completed by September 20, 2021.
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Based on record review and licensee’s admission, licensees do not have current mandated reporter training certificates on file which poses a potential risk to children in care.
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Type B
10/14/2021
Section Cited
CCR102417(g)(1)

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102417(g)The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to:
(1)The home shall contain a fire extinguisher and smoke detector device which meet standards This requirement was not met as evidenced by:
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Licensee stated a smoke detector will installed on 9/14/21. Licensee stated a video will be submitted of the fire detector for review by September 15, 2021.
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Licencee did not have an operational smoke or carbon monoxide detector during the annual inspection.
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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:Jason Garay
LICENSING EVALUATOR NAME:Casey Gulley
LICENSING EVALUATOR SIGNATURE:
DATE: 09/14/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/14/2021


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