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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444417665
Report Date: 06/22/2023
Date Signed: 06/27/2023 04:40:39 PM

Document Has Been Signed on 06/27/2023 04:40 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:MURILLO, MAFACILITY NUMBER:
444417665
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
06/22/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Ma MurilloTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Elizabeth Berumen met with Applicant, Ma Murillo to conduct an announced pre-licensing inspection to the home today. Present during the inspection was Applicants two minor children. The adults that reside in the home are the Applicant, and her husband, Antonio Meneses-Rojas. Applicant has two minor children ages 8 and 17. Applicants son will be 18 in June of 2024. LPA reminded her that once her son turns 18 he is to be fingerprinted. LPA also advised applicant that her children under the age of 10 will count in her capacity when they are present.

Days and hours of operation will be Monday - Saturday from 6:00 AM to 5:00 PM. Applicant has completed her Preventative Health and Safety Child Care Training on May 3, 2023 and a copy of the certification is on file. Applicant's CPR and First Aid certifications are current and expire on March 12, 2025 . Applicant completed Mandated Reporter training on February 27, 2023. Applicant has immunization against measles, pertussis and influenza. Applicant owns the mobile home; LPA obtained a copy of property taxes during today's inspection. Currently, Applicant does not have liability insurance and will issue affidavit regarding liability insurance for Family child care home.

LPA inspected the indoor and outdoor areas during today's visit. Off limit areas inside the home: bedroom 1, bedroom 2, bedroom 3, bedroom 4 including bathroom and laundry area. Outdoor play area is fenced and safe for the children. The smoke detector and carbon monoxide detectors were tested and proved to be functioning. LPA observed a 2A10BC fire extinguisher. LPA observed a furnace in the laundry room. Detergents, cleaning compounds, medicines, and other items which could pose a danger if readily available to children are stored where they are inaccessible. Applicant understands that poisons are to be locked.
Applicant states that there are no weapons in the home and no pets. LPA reminded Applicant that smoking, baby walkers, bouncers, jumpers, and similar items are not allowed in Family Child Care Homes.

A review of staff records on 06/21/2023 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Ma Murillo 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.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE: DATE: 06/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/22/2023
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: MURILLO, MA
FACILITY NUMBER: 444417665
VISIT DATE: 06/22/2023
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LPA reviewed with Ma Murillo 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. Applicant understands that children's personal rights should not be violated; including no corporal punishment. Applicant states she will talk to children and redirect them as form of discipline. LPA discussed the following with Applicant; Isolation of sick children, supervision of children, capacity options, transportation of children, requirements for reporting suspected child abuse, unusual incidents/injuries, heat related illnesses, and requirements for assistant/substitute. LPA informed Applicant that fire/disaster drills must be practiced at least once every 6 months and documented. Applicant understands that she is to keep a current children's roster.


LPA discussed the safe sleep regulations with Ma Murillo 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 Ma Murillo 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.

LPA discussed the requirements of AB 633 with the Applicant and provided her the AB 633 fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) and Applicant understands the requirements. LPA also discussed "zero tolerance" related regulations with the Applicant and advised her of the assessment of an immediate $500 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



Incidental Medical Services (IMS) policy was discussed. 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. SB 792 Immunization Requirements was also discussed.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023
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: MURILLO, MA
FACILITY NUMBER: 444417665
VISIT DATE: 06/22/2023
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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.

Ma Murillo updated the LIC279 to change the ages of children she will care for. An updated LIC279 was provided to LPA during today's inspection.

Exit interview was conducted in Spanish and report was reviewed with Applicant, Ma Murillo.

A small (capacity 8) will be approved pending manager approval.

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023
LIC809 (FAS) - (06/04)
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