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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414381
Report Date: 08/19/2024
Date Signed: 08/28/2024 09:38:11 AM

Document Has Been Signed on 08/28/2024 09:38 AM - 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:MAZA-OCHOA, MICHELLEFACILITY NUMBER:
434414381
ADMINISTRATOR/
DIRECTOR:		MAZA-OCHOA, MICHELLEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 391-9663
CITY:PALO ALTOSTATE: CAZIP CODE:
94303
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
08/19/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:55 AM
MET WITH:Michelle Maza-OchoaTIME VISIT/
INSPECTION COMPLETED:
02:05 PM
NARRATIVE
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On 08/19/2024 at 11:55am, Licensing Program Analyst (LPA) Jialing “Julianne” Zhu met with licensee Michelle Maza-Ochoa for an unannounced annual inspection. Present during the inspection were licensee and four (4) children (1 infant and 3 preschool-aged) 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 7:30am – 5:30pm.

The facility is a single-story home with three (3) bedrooms, two (2) bathrooms, living room, dining room, kitchen, familu room, laundry area, attached garage, front yard, and backyard. The on-limit areas are living room, dining room, Room 3, bathroom by Room 3, and backyard. The off-limit areas are Room 1, Room 2, kitchen, family room, laundry area, garage, and sides of backyard, which will be inaccessible by closed and/or locked doors and visual supervision. The isolation area is a corner of the living room. When a child shows signs of illness, he/she will be separated from other children here.

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. There is a fully charged 3A40BC fire extinguisher on the wall of the hallway. LPA observed one (1) working smoke detector and one (1) working carbon monoxide detector in the dining room. The home is equipped with telephone service and a fully stocked first aid kit. All toxins, cleaning products, and hazardous materials have been made inaccessible to the children. Wall heaters are properly barricaded and made inaccessible to children in care. There are two (2) small dogs in the home. Per licensee, there are no firearms in the home.

LPA observed three (3) play yards are in the facility with the correct size mattresses and fitted sheets. Sleeping cots are available for non-infant children. Licensee provides bedding to the children during nap time. Licensee provides AM/PM snacks and lunch for the children. Licensee does not transport children by vehicle, but she goes on neighborhood walks with children after obtaining permission from parents.

Page 1 of 3. See LIC 809C.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Jialing Zhu
LICENSING EVALUATOR SIGNATURE: DATE: 08/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/19/2024
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 4
Document Has Been Signed on 08/28/2024 09:38 AM - It Cannot Be Edited


Created By: Jialing Zhu On 08/19/2024 at 12:50 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
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: MAZA-OCHOA, MICHELLE
FACILITY NUMBER: 434414381

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/19/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above as 1 of 1 infant enrolled and present during today's inspection did not have LIC 9227. 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 have parents of the enrolled infant fill out the LIC 9227. Licensee will email the signed LIC 9227 to LPA at 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: 08/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/19/2024


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: MAZA-OCHOA, MICHELLE
FACILITY NUMBER: 434414381
VISIT DATE: 08/19/2024
NARRATIVE
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The outdoor play area is the fenced off portion of the backyard, which is completely fenced with visual supervision. 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, and gates are locked at all times while children are in the backyard. Per licensee, she also supervises outdoor play time at the neighborhood park. 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 03/06/2026. Licensee has completed the Mandated Reporter training for Child Care Providers, however it has expired on 07/16/2023. 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 at least once every six months, and the last conducted drill was on 05/10/2024. All required documents are posted and visible for public review.

LPA reviewed five (5) children’s files. There is a current roster available for review. Licensee currently does not have any assistants for her facility. The licensee rents the property. The facility does not have liability insurance, and the Affidavit Regarding Liability Insurance forms (LIC 282) 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.

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.

Page 2 of 3. See LIC 809C.

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

DATE: 08/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: MAZA-OCHOA, MICHELLE
FACILITY NUMBER: 434414381
VISIT DATE: 08/19/2024
NARRATIVE
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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.

One (1) deficiency and three (3) Advisory Notes were issued during today’s inspection. Please see attached advisory note pages for information on technical violations (TV) issued today. Note that technical violations are not citations but are advisory notes.

Type B Deficiency: 1 of 1 infant enrolled and present during today's inspection did not have LIC 9227.

Advisory Notes (TV): 15-minute checks for infants (0-24 months) when sleeping were conducted but not documented; 3 of 5 children's files reviewed by LPA showed each child is missing one (1) DTap shot; licensee's Mandated Reporter Training for Child Care Providers expired in 07/16/2023.

A Notice of Site Visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Michelle Maza-Ochoa. LPA provided licensee a copy of the Appeal Rights.

Page 3 of 3. End of Report.

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

DATE: 08/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2024
LIC809 (FAS) - (06/04)
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