434413653-9-27-2024-52-CC-JZHU-D9HURC-20240927154831

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434413653
Report Date: 09/27/2024
Date Signed: 09/27/2024 03:48:39 PM

Document Has Been Signed on 09/27/2024 03:48 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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	TERRAZAS, AMOR		FACILITY NUMBER:	434413653
ADMINISTRATOR/ DIRECTOR:	TERRAZAS, AMOR		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 468-1788
CITY:	PALO ALTO	STATE: CA	ZIP CODE:	94306
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 11	DATE:	09/27/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:30 PM
MET WITH:	Amor Terrazas		TIME VISIT/ INSPECTION COMPLETED:	04:00 PM

NARRATIVE

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On 09/27/2024 at 1:30pm, Licensing Program Analyst (LPA) Jialing “Julianne” Zhu met with licensee Amor Terrazas for an unannounced annual inspection. Present during the inspection were licensee, three (3) fingerprint-cleared family members , three (3) fingerprint-cleared assistants, and 11 children in care. The licensee is within ratio today. Upon arrival, LPA provided licensee a copy of the Entrance Checklist (LIC 126). The home was toured to conduct a Health and Safety Inspection. The facility’s current hours of operation are Monday - Friday from 8:30am - 4:30pm.

On-limits: playroom, living room, hallway bathroom, backyard with an elevated deck area

Off-limits: primary bedroom & bathroom, 1^st & 2^nd bedrooms on right side of hallway, side yard, kitchen*
Isolation Area: living room and playroom

*Kitchen: placed off-limits as of today’s inspection. Children will pass by the corner of the kitchen when entering the living room through the backyard or playroom. Since a part of the kitchen will be accessible, licensee and/or assistants will provide 100% supervision when children are walking past the kitchen.

The facility is a single-story home rented by the licensee. The entrance for the day care is the gate on the right side of the home. The inside of the home is observed to be clean and orderly, with central heating and ventilation for safety and comfort. The living room is also equipped with an air conditioning unit. LPA observed there are ample safe and age-appropriate toys, play equipment and materials. All toxins, cleaning products, and hazardous materials have been made inaccessible to children. Per licensee, there are no firearms and no pets in the home.

The home is equipped with telephone service and fully stocked first aid kits availble inside and outside. There is a fully charged 3A40BC fire extinguisher in the playroom. The facility is equipped with at least one working smoke detector and carbon monoxide detector. There is a fireplace in the living room that is screened to make it inaccessible to children in care. A waiver has also been granted previously for the fireplace.

Page 1 of 4. See LIC 809C.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Jialing Zhu
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 7

Document Has Been Signed on 09/27/2024 03:48 PM - It Cannot Be Edited

Created By: Jialing Zhu On 09/27/2024 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
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: TERRAZAS, AMOR	FACILITY NUMBER: 434413653
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/27/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

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 record review, the licensee did not comply with the section cited above as 2 of 3 staff files reviewed by LPA did not have proof of immunization for MMR and 1 of 3 staff files reviewed did not have proof of immunization for Tdap, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/18/2024
	Plan of Correction
1 2 3 4	Staff missing MMR and/or Tdap immunizations will obtained proof of immunization. Licensee will email proof of immunizations to LPA at jialing.zhu@dss.ca.gov by 10/18/2024.

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:

Chandra Charles

LICENSING EVALUATOR NAME:

Jialing Zhu

LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2024

LIC809 (FAS) - (06/04)

Page: 2 of 7

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: TERRAZAS, AMOR	FACILITY NUMBER: 434413653
	VISIT DATE: 09/27/2024

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Sleep cots are available to the children. Licensee provides sheets for the sleep cots, and children bring their own blankets. Licensee provides AM/PM snacks to children, and children bring meals from home. All beddings and food brought from children’s home are be labeled with the children’s name and stored appropriately.

The outdoor play area is the backyard, which is fully fenced. The outdoor play area is free from defects or dangerous conditions. There is an ample supply of age-appropriate toys and activities available for children, and they are in good condition. There is ample shade available. The shaded area is used for arts and crafts and is equipped with water tables, playhouse, and a play structure that is bolted into the ground. The ground surrounding the play structure is padded with a rubber material, and the rest of the backyard is padded with turf. The left side of the backyard is off limits with a chicken coop, currently not in use. Gates are locked at all times while children are in the backyard. There are no pools or similar bodies of water on premises.

The licensee completed the Health and Safety training. The licensee’s Pediatric CPR/First Aid certification is current and expires on 04/07/2025. Licensee has completed the Mandated Reporter training for Child Care Providers and expires on 08/20/2025. The licensee is in compliance with the immunization laws. All adults living in the home have obtained a criminal record clearance and/or exemption.

LPA reviewed six (6) children’s files and three (3) staff files. There is a current roster available for review. The facility does not have liability insurance, and the Affidavit Regarding Liability Insurance forms (LIC 282) were reviewed.

The licensee conducts and documents fire/disaster drills at least once every six months. The last drill was an earthquake drill conducted on 08/22/2024. All required documents are posted and visible for public review.

Licensee was reminded that California Law requires licensees to report unusual incidents or injuries to children in care, to child's parents, and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624B). Any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing. Incidents must be reported within 24 hours by phone, fax, or email. LPA informed the Licensee that all forms can be downloaded at www.ccld.ca.gov.

Page 2 of 4. See LIC 809C.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Jialing Zhu
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2024

LIC809 (FAS) - (06/04)

Page: 5 of 7

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: TERRAZAS, AMOR	FACILITY NUMBER: 434413653
	VISIT DATE: 09/27/2024

NARRATIVE

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Licensee was also reminded that Mandated Reporter Training ("Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting https://mandatedreporterca.com/. Licensee was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years.

Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

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.

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) or (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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Page 3 of 4. See LIC 809C.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Jialing Zhu
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2024

LIC809 (FAS) - (06/04)

Page: 6 of 7

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: TERRAZAS, AMOR	FACILITY NUMBER: 434413653
	VISIT DATE: 09/27/2024

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One (1) Type B deficiency and two (2) Advisory Notes (Technical Violations) were issued during today’s inspection

Type B Deficiency: 2 of 3 staff files reviewed by LPA did not have proof of immunization for MMR. 1 of 3 staff files reviewed did not have proof of immunization for Tdap.

Advisory Notes (TVs): 3 of 6 children's files reviewed by LPA did not have up-to-date immunization records; one (1) staff file reviewed by LPA did not have a current Mandated Reporter certificate.

A Notice of Site Visit was given and must remain posted for 30 days. Exit interview was conducted, report was reviewed, and Appeal Rights were provided to licensee Amor Terrazas.

Page 4 of 4. End of Report.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Jialing Zhu
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2024

LIC809 (FAS) - (06/04)

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