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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414370
Report Date: 08/02/2024
Date Signed: 08/02/2024 02:06:27 PM

Document Has Been Signed on 08/02/2024 02:06 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:ALVAREZ FALCONI, KARLAFACILITY NUMBER:
434414370
ADMINISTRATOR/
DIRECTOR:		ALVAREZ FALCONI, KARLAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 806-0403
CITY:PALO ALTOSTATE: CAZIP CODE:
94303
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
08/02/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Karla Alvarez FalconiTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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On 08/02/2024 at 11:00am, Licensing Program Analyst (LPA) Jialing “Julianne” Zhu and Licensing Program Manager (LPM) Chandra Charles, met with licensee Karla Alvarez Falconi for an UNANNOUNCED ANNUAL INSPECTION. Present during the inspection were licensee, one (1) fingerprint-cleared resident of home, and four (4) children in care. Licensee’s two (2) minor children were also present in the home. 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 through Thursday from 7:30am until 5:00pm, Friday 7:30am-4:30pm.

The home is a single-story home with four (4) bedrooms, two (2) bathrooms, living room, dining room, family room, kitchen, attached garage, front yard, and backyard. The on-limit areas are Bedroom 4 (nap room), one (1) bathroom, living room, dining room, and backyard. The living room and dining room are used as the main day care area. The off-limit areas are three (3) bedrooms, one (1) bathroom, family room, garage, and front yard, which will be inaccessible by closed and/or locked doors and visual supervision. Bedroom 2 is off-limits and only used as a walkthrough to access the nap room with 100% adult supervision. The isolation area is a section of the main day care area. When a child shows signs of illness, he/she will be separated from other children here. Parents and children enter the facility through the gate. Parents call or text licensee when they arrive at the facility.

The inside of the home is observed to be clean and orderly, with central heating and ventilation for safety and comfort. 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 the children. There is a fireplace in the living room that is made inaccessible to children. The licensee has one (1) small dog that is kept in the primary bedroom or a fenced off section of the backyard when children are in care. Per licensee, there are no firearms in the home.

Page 1 of 4. See LIC 809C.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Jialing Zhu
LICENSING EVALUATOR SIGNATURE: DATE: 08/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/02/2024
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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: ALVAREZ FALCONI, KARLA
FACILITY NUMBER: 434414370
VISIT DATE: 08/02/2024
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There are fully charged 3A40BC fire extinguishers in living room and kitchen, smoke detectors, and a carbon monoxide detector. LPA tested one (1) smoke detector and one (1) carbon monoxide detector, and both are in working order. The home is equipped with telephone service and a fully stocked first aid kit.

Play yards are also in the facility with the correct size mattresses and fitted sheets. Licensee provides bedding to the children during nap time. Licensee provides AM/PM snacks and lunch for the children. All beddings and food brought from children’s home are to be labeled with the children’s name and stored appropriately. She does not transport children to or from the facility.

The outdoor play area is the backyard, which is completely fenced with visual supervision. 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 a shed with a lock to prevent children’s access to the equipment stored inside. There is ample shade available, and gates are locked at all times while children are in the backyard. There are no pools or other bodies of water on premises today.

The licensee completed the Health and Safety training. The licensee’s Pediatric CPR/First Aid certification is current and expires on 08/27/2024. Licensee has completed the Mandated Reporter training for Child Care Providers (AB1207) and expires on 02/08/2025. The licensee is in compliance with the immunization laws. All adults living in the home have obtained a criminal record clearance. The licensee conducts and documents fire and disaster drills twice a year and the last conducted drill was on 07/08/2024. All required forms are posted and visible for public review.

LPA reviewed four (4) children’s files. There is a current roster available for review. The facility does not have liability insurance, and the LIC 282 Affidavit Regarding Liability Insurance forms were reviewed.

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.

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.

Page 2 of 4. See LIC 809C.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Jialing Zhu
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2024
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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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: ALVAREZ FALCONI, KARLA
FACILITY NUMBER: 434414370
VISIT DATE: 08/02/2024
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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.

Licensee was informed of the MyChildCarePlan.org site, 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.

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: 08/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2024
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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: ALVAREZ FALCONI, KARLA
FACILITY NUMBER: 434414370
VISIT DATE: 08/02/2024
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One (1) deficiency is cited during today's inspection.

Two (2) Type B Deficiency:

  • One (1) infant was sleeping in the nap room with the door closed.

A Notice of Site Visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Karla Alvarez Falconi. The report shall be kept in the facility file for three (3) years. LPA provided licensee a copy of the Appeal Rights.

Page 4 of 4. End of Report.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Jialing Zhu
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/02/2024 02:06 PM - It Cannot Be Edited


Created By: Jialing Zhu On 08/02/2024 at 01:45 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: ALVAREZ FALCONI, KARLA
FACILITY NUMBER: 434414370

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/02/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(5)
The provider shall supervise infants while they are sleeping and adhere to the following requirements: If the infant is sleeping in a separate room from where the provider is stationed, the door to the room the infant is sleeping in shall remain open at all times.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above as LPA observed one (1) infant in the on-limit nap room napping with the door closed, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/30/2024
Plan of Correction
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Licensee will email to LPA a written statement of understanding of the regulation cited above regarding infant safe sleep to jialing.zhu@dss.ca.gov by 08/30/2024.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Chandra Charles
LICENSING EVALUATOR NAME:Jialing Zhu
LICENSING EVALUATOR SIGNATURE:
DATE: 08/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/02/2024


LIC809 (FAS) - (06/04)
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