013411184-6-14-2023-02-CC-ILOA-CSSQFJ-20230614120800

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013411184
Report Date: 06/14/2023
Date Signed: 06/14/2023 12:08:08 PM

Document Has Been Signed on 06/14/2023 12:08 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	CHAIREZ, MARIA		FACILITY NUMBER:	013411184
ADMINISTRATOR:	CHAIREZ, MARIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 524-5012
CITY:	BERKELEY	STATE: CA	ZIP CODE:	94710
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 12	DATE:	06/14/2023
TYPE OF VISIT:	Case Management - Annual Continuation	UNANNOUNCED	TIME BEGAN:	09:12 AM
MET WITH:	Maria Chairez		TIME COMPLETED:	12:14 PM

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On June 14, 2023 at approximately 9:12am Licensing Program Analyst (LPA) Indira Loza arrived and met with the licensee Maria Chairez for the purpose of conducting an unannounced continuation annual inspection. Present for today’s inspection were the Licensee, two assistants and 11 children in care (2 infants; 9 preschool age children). The facility is in ratio today. Hours of operation are Monday - Friday 8:00am - 5:00pm.

The facility is a single-story home with two bedrooms; one and a half bathrooms (one inside the house, and a half bathroom, which is connected to the city water pipes, in the backyard for the children to use); a living room; dining room; kitchen; attached converted garage; front, back and side yards. The home has heating and ventilation for safety and comfort. Per the licensee, the ISOLATION AREA will be in the living room or child’s napping room away from the other children in care. All required postings are present.

ON LIMIT AREAS: Living room; hallway leading to the bathroom on the left side of the hall and the second bedroom at the end of the hall, the enclosed patio area, the entire backyard, and the converted garage, which is used as a play area.

OFF LIMIT AREAS: Licensee's bedroom on the right of the hallway, kitchen (only used to walk through to the garage); and the front and side yard. The off-limit areas will be inaccessible by child gates, closed and/or locked doors and adult supervision.

The home has a fully charged 2A10BC fire extinguisher mounted on the wall next to the kitchen, smoke and carbon monoxide detectors (tested and working) and a working telephone. Fire drills are conducted at least once every 6 months, the last drill completed was in June 4, 2023. The Licensee has ample age-appropriate toys and learning materials inside and outside the home. The outdoor play area is free from defects and dangerous conditions. Toxins, medicines, and hazardous items were inaccessible during

************************************Report Continues on LIC 809-D********************************

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:	DATE: 06/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2023

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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: CHAIREZ, MARIA	FACILITY NUMBER: 013411184
	VISIT DATE: 06/14/2023

NARRATIVE

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today's inspection. LPA reviewed facility files including records for staff and Children’s files. The facility roster was reviewed, and a copy obtained. Children’s files were complete and well organized. The licensee owns the property and has liability insurance provided by State Farm. Licensee had a current CPR/1^st Aid certificate which expires 3/24. All staff had a current Mandated Reporter certificate.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02. 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

Licensee was reminded 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.

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.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

*****************************Report Continues on LIC 809-C***************************

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:	DATE: 06/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2023

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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: CHAIREZ, MARIA	FACILITY NUMBER: 013411184
	VISIT DATE: 06/14/2023

NARRATIVE

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Licensee was reminded that children are not allowed to eat or sleep in the converted garage.

There was one Type B deficiency cited during today's visit. See LIC 809-D for citation. This report will remain on file for three years.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Licensee Maria Chairez.

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:	DATE: 06/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/14/2023 12:08 PM - It Cannot Be Edited

Created By: Indira Loza On 06/14/2023 at 11:34 AM

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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: CHAIREZ, MARIA	FACILITY NUMBER: 013411184
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/14/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.622(c)

Administration of Child Day Care Licensing

(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above in 2 out of 3 staff have did not have their immunization record on file which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/14/2023
	Plan of Correction
1 2 3 4	The Licensee shall email the required immunizations to the LPA no later than July 14, 2023.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Mayla Mendoza

LICENSING EVALUATOR NAME:

Indira Loza

LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2023

LIC809 (FAS) - (06/04)

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