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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376629162
Report Date: 08/06/2021
Date Signed: 08/06/2021 12:38:10 PM

Document Has Been Signed on 08/06/2021 12:38 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:MIRANDA, KEYLLY FAMILY CHILD CAREFACILITY NUMBER:
376629162
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 14CENSUS: 2DATE:
08/06/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Keylly MirandaTIME COMPLETED:
12:45 PM
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On 08/06/21 at 10:20AM, LPA, Luigi Gargaro, conducted an announced prelicensing inspection for a relocation with the applicant to ensure compliance with standards established in CCR, Title 22, Division 12, Chapter 3, for Family Child Care Homes. The one story home was toured and inspected to ensure an environment safe for the care and supervision of children. The fire extinguisher and smoke and carbon monoxide detectors meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children. The applicant was asked whether she had any bodies of water or weapons in the home and she replied no. CPR and First Aid expire on July of 2023 for the applicant. 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. Applicant owns the home and submitted proof of control of property in the form of a grant deed with her original application.

Applicant will be using the following rooms for childcare: the living room, the second home bedroom and the bathroom. Off limits are the first bedroom (listed as "room 3" on the facility sketch), the kitchen, the bedroom behind the kitchen (listed as "room 1" on the facility sketch) and the garage. The first bedroom is made off limits with a locking door handle. The kitchen is made off limits with a secured, extended child safety gate that is installed between the living room and the kitchen. The garage entrance door and the back bedroom are located behind the off limits kitchen and are therefore inaccessible. The home does have a wall heating unit that applicant attested is non-operable. Applicant understands that if it is ever repaired prior to use she must install a safety gate or other device that makes it inaccessible to children in care. The applicant has sufficient toys and equipment available.

The home has a fenced backyard but it will currently be made off limits as applicant has some personal items and plants that need to be removed before it can be made available for use. Applicant does have a gated front yard that was inspected and is safe for use at her discretion. Applicant may also take children to a local park for outdoor play as an alternate option.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Luigi Gargaro
LICENSING EVALUATOR SIGNATURE: DATE: 08/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/06/2021
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: MIRANDA, KEYLLY FAMILY CHILD CARE
FACILITY NUMBER: 376629162
VISIT DATE: 08/06/2021
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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. LPA and applicant discussed California Megan's Law and he provided applicant with the website address: www.meganslaw.ca.gov for her to review information regarding her facility on a regular basis.

Applicant was reminded of requirements for children’s records, child abuse and unusual incident reporting, immunizations, adults living or working in the home and associated civil penalties, shaken baby syndrome, and SIDS. Applicant was reminded that corporal punishment, smoking, walkers, exersaucers, bouncy seats and jumpers are not allowed in day care.

No corrections are required and a license for 8 will be issued today at this new location.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Luigi Gargaro
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2021
LIC809 (FAS) - (06/04)
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