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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416751
Report Date: 11/18/2021
Date Signed: 11/18/2021 11:29:30 AM

Document Has Been Signed on 11/18/2021 11:29 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:MORGAN, RICHARD & FLORES, ALEXANDRIAFACILITY NUMBER:
434416751
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
11/18/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:52 AM
MET WITH:Richard MorganTIME COMPLETED:
11:40 AM
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On November 18, 2021 at 8:52 AM, Licensing Program Analyst (LPA) Marilou Monico conducted an announced Prelicensing inspection in response to a change of location. LPA met with Applicant, Richard Morgan, and explained the purpose of today's inspection. LPA notes that the Applicants, Richard Morgan and Alexandra Flores, are currently licensed at 1134 Boynton Avenue, San Jose, CA 95117 (Facility number: 434417007).

9:00 AM - Application/Record Review: Both applicants are the adults residing in the home. The Applicants reside in a one-storey, three-bedroom and two-bathroom house. Days and hours of operation will be Monday to Friday from 7:00 AM to 5:00 PM. The Applicants' CPR and First Aid certifications are current, with an expiration date of July 10, 2023 . Both applicants have current Mandated Reporter Training for Child Care Workers. The Applicants rent the home and Property Owner/Landlord Notification (LIC 9151) as well as verification of control of property were submitted to Licensing. All individuals subject to a criminal record review have obtained a criminal record and child abuse index clearances prior to today's inspection.

9:20 AM - Physical Plant tour: There is a working telephone in the home (650) 660-8080. The home is clean and has heating and ventilation for safety and comfort. The off limit areas inside the home: one bedroom, one bathroom, and garage. There are no off limit areas outside the home. There are safe and age appropriate toys, play equipment, and materials for the children in the home. The Applicants have a designated area in the home where a child(ren) can be isolated if exhibiting signs of illness. The home has working smoke detector and carbon monoxide detector. The home has a fire extinguisher (3A40BC) that is fully charged. Richard states that there are no firearms in the home. All cleaning compounds, sharp objects, medications, and other similar items are stored inaccessible to the children. Richard understands that baby walkers, baby bouncers, jumpers, and saucer chairs are not allowed in the home. Richard states that no one in the home smokes and he understands that smoking is prohibited in the home. LPA observed first aid kit. There were no bodies of water observed.

Continuation on next pages:
SUPERVISORS NAME: Anthony Studebaker
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE: DATE: 11/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/18/2021
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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: MORGAN, RICHARD & FLORES, ALEXANDRIA
FACILITY NUMBER: 434416751
VISIT DATE: 11/18/2021
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9:50 AM - Kitchen tour: The refrigerator and freezer in the home is clean. Richard understands that any food/drink which is brought by parent(s) of day care child(ren) must be properly labeled with the child(ren) name and properly stored or refrigerated. Cleaning products are stored in a locked cabinet under the sink.

9:55 AM - Bathroom tour: The toilet and faucet are clean, safe, and operable. Sharp objects and cleaning products are stored inaccessible to children.

10:00 AM - Document/Regulation Review: A Family Child Care Home packet with updated Licensing forms was provided to Richard. Documents from the packet, including but not limited to the following were discussed and reviewed with Richard: 1) Child Care Facility Roster (LIC 9140) must be complete and current at all times, 2) Fire/disaster drills must be practiced at least once every 6 months and documented on the fire/disaster drill log provided to the Applicant, 3) Posting requirements - Parent's Rights (PUB 394), Emergency Disaster Plan (LIC 610A), Earthquake Preparedness Checklist (LIC 9148), and Facility License, 4) Staffing & Ratio - capacity/ratio limitations handout, 5) Safe Sleep Regulations (PIN 20-24-CCP), 6) Lead Flyer Requirement (PIN 20-01-CCP), and 7) Forms and Records to keep in your Family Child Care Home (LIC 311D).

LPA discussed the safe sleep regulations with Richard and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Richard 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.

Richard states that they will talk to the children and use redirection as forms of discipline. Richard understands that children's personal rights should not be violated; including no corporal punishment, supervision of children, transportation of children, requirements for reporting suspected child abuse, unusual incidents/injuries, heat related illnesses, and requirements for assistant/substitute were also discussed with the Richard.
Continuation on next page:
SUPERVISORS NAME: Anthony Studebaker
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2021
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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: MORGAN, RICHARD & FLORES, ALEXANDRIA
FACILITY NUMBER: 434416751
VISIT DATE: 11/18/2021
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Incidental Medical Services (IMS) policy was discussed with Richard. 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. Richard states that they are not planning on administering medication to the day care children at this time.

10:50 AM - Notification requirements/civil penalty: LPA discussed the requirements of AB 633 with Richard. He understands the AB 633 fact sheet/copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224). LPA discussed "zero tolerance" related regulations with the Richard and advised him of the assessment of an immediate $500 per day civil penalty for any violation of a "zero tolerance" related regulation. An ongoing civil penalty of $100 per day continues until the violation(s) is corrected.

LPA advised Richard that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Exit interview conducted and report was reviewed with the Applicant, Richard Morgan.

LPA advised Richard that a license for a Small Family Child Care Home will be approved pending the receipt of the following items:
1) Photos showing that the two wall heaters located in the hallway are barricaded half way from the bottom.
2) Letter signed by Applicants to close the current license #434417007
SUPERVISORS NAME: Anthony Studebaker
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2021
LIC809 (FAS) - (06/04)
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