376628634-9-1-2021-20-CC-MMAE-C6FR83-20210901124717

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376628634
Report Date: 09/01/2021
Date Signed: 09/01/2021 12:47:29 PM

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:	AJA MAZA, NATALIA FAMILY CHILD CARE		FACILITY NUMBER:	376628634
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 4	DATE:	09/01/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:09 AM
MET WITH:	Natalia Aja Maza		TIME COMPLETED:	01:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On September 1, 2021, at 11:09am, Licensing Program Analyst (LPA), Martha Malane conducted an unannounced Annual Inspection and met with Licensee, Natalia Aja Maza. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Licensee. Four (4) children and licensee were present in the facility during this inspection. This facility is a single story, two (2) bedroom, one (1) bathroom apartment. Licensee accompanied LPA inside and out of the facility during this inspection. The following areas used for child care are: living room, kitchen, bathroom, bedroom #2 and front yard. Off limits areas are bedroom #1 and side yard and are inaccessible through use of latches, locks and door locks. The fire extinguisher, smoke detector, and carbon monoxide detector met requirements. All hazardous items were inaccessible to children. Licensee has toys, play equipment and materials available for children. The home has a fenced front yard available for outdoor activities. Licensee stated there are no bodies of water and LPA did not observe any bodies of water on the premises during the inspection. Licensee stated there are no weapons in the home. Or LPA observed locked storage area(s) for firearms and other dangerous weapons. 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 First Aid and CPR certifications expire 7/22/2022. Licensee has required immunizations. Licensee completed Mandated Reporter Training 6/16/2020. Facility roster is maintained and was reviewed. The last fire and disaster drills were conducted and documented on 4/5/2021. Licensee provides care for children 2.5 – 7 years. Licensee will send an updated LIC279 to CCL. LPA provided and discussed the following: Report suspected child abuse and neglect, maintain 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. See continuation LIC809C

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Martha Malane	TELEPHONE: (619) 767-2231
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2021

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
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: AJA MAZA, NATALIA FAMILY CHILD CARE	FACILITY NUMBER: 376628634
	VISIT DATE: 09/01/2021

NARRATIVE

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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 PIN 21-24 CCP regarding Safe Sleep Regulations/SIDS and PIN21-02 CCLD for Guardian. LPA and licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov and 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.

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.

No deficiencies cited

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.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Martha Malane	TELEPHONE: (619) 767-2231
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2021

LIC809 (FAS) - (06/04)

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