444416739-5-16-2023-07-CC-EBEN-CRVLXD-20230516090831

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444416739
Report Date: 05/09/2023
Date Signed: 05/16/2023 09:09:12 AM

Document Has Been Signed on 05/16/2023 09:09 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:	MARAVILLA, NANCY		FACILITY NUMBER:	444416739
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	05/09/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Nancy Maravilla		TIME COMPLETED:	12:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Elizabeth Berumen met with applicant, Nancy Maravilla, to conduct a pre-licensing visit. Applicant states there are four adults living in the home, herself, her husband (Gabriel Martell Salinas), daughter (Alejandra Martell Salinas) and her cousin, (Jose Reyes). LPA observed Jose Reyes during today's inspection. LPA notes that Jose is not listed on the Application (LIC279). Applicant's father owns the home; Applicant will submit consent from landlord. Applicant provided LPA with the LIC9151. Applicant plans to get liability insurance in the future and she understood that while she does not have liability insurance, she will have parent/authorized representative sign the Affidavit Regarding Liability Insurance for FCCH form (LIC 282). A listing of staff criminal record clearances associated to this facility in the CCL Licensing Information System (LIS) on 05/04/2023 was reviewed and it indicates that NOT all Facility staff or other individuals who require caregiver background clearances have received criminal record and child abuse index clearances or exemptions. Applicant 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, 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. The entire home was inspected for health and safety hazards. The home has a working smoke detector, a working carbon monoxide detector, a 3A40BC fire extinguishers that was fully charged. There is a working telephone in the home. Certifications for CPR and First Aid expire 06/14/23. Preventative Health Practices training was complete on 06/14/21. Applicant has completed Mandated Reporter training on 01/2/22, and expires on 01/02/24. Immunization's for Measles and Pertussis are on file. Applicant declines the influenza vaccine.

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023

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 3

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: MARAVILLA, NANCY	FACILITY NUMBER: 444416739
	VISIT DATE: 05/09/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Applicant stated that there were no weapons in the home. LPA observed a screened fire place in day care room area. Applicant fenced off a portion of her backyard for day care children. LPA observed a studio in the backyard behind the fence that is not on the facility sketched. Off limit areas: four bedrooms, one bathroom in master bedroom, garage and outdoor studio, fenced off portion of the backyard. There is a storage shed in off limit left corner of the backyard; there is a fence to prevent access.

The days and hours of operation will be Monday through Friday from 7:00 am to 5:00 pm.
Cleaning products, hazardous and sharp objects were inaccessible to children and stored inaccessible to children. Discipline policy was discussed with applicant and she understood that the children's personal rights should not be violated and corporal punishment is not allowed. Applicant states she will use redirection and talk to children as form of discipline. Applicant stated they will not transport children; they understood the safety seat belt/car seat requirements.

A Family Child Care Home packet was reviewed with applicant. Department's website: www.ccld.ca.gov to obtain forms and regulations CCR, Title 22 was provided. Applicant was advised on the regulations that smoking, baby walkers, bouncers, excersaucers and other similar items are not allowed. The following was discussed, isolation of sick children; supervision of children; capacity options; requirements for reporting suspected child abuse; unusual incident/injuries; fire drills practiced at least twice a year and documented. LPA also discussed the requirements of AB 633 to applicant and provided applicant the fact sheet and a copy of Acknowledgement of receipt of Licensing Reports (LIC 9224). Zero Tolerance deficiencies with $500 civil penalty was also explained to applicant. LPA reviewed with applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

LPA discussed the safe sleep regulations with applicant 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 applicant 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.

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023

LIC809 (FAS) - (06/04)

Page: 3 of 3

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: MARAVILLA, NANCY	FACILITY NUMBER: 444416739
	VISIT DATE: 05/09/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Continuation of report dated 05/09/2023 ______________________________ pg. 3/3

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 platform. 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.

Exit interview conducted and report was reviewed in Spanish with the applicant, Nancy Maravilla. LPA advised applicant that a license for a small (capacity 8) Family Child Care Home license is approved pending the following:

- Update facility sketch to include backyard studio
- Fingerprint clearance for Jose Reyes.
- Updade LIC279
-LIC 9149 (landlord consent).
- Applicant stored items (toiletries, shampoos, etc) that were under the bathroom sink in an inaccessible area during todays inspection.

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3