013423587-10-5-2023-02-CC-RDUT-CWBPKS-20231005112338

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013423587
Report Date: 10/05/2023
Date Signed: 10/05/2023 11:23:50 AM

Document Has Been Signed on 10/05/2023 11:23 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 CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	ANDRADA, MIYANI		FACILITY NUMBER:	013423587
ADMINISTRATOR:	ANDRADA, MIYANI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 332-8806
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94605
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 11	DATE:	10/05/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Aislinn Martinez		TIME COMPLETED:	11:30 AM

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	On 10/5/2023 Licensing Program Analysts (LPAs) Randall Dunevant and Briana Plumboy arrived at the home for an unannounced Required - 1 year inspection. LPA met with assistant Aislinn Martinez and Licensee Miyani Andrada. There were 5 infants and 6 children in care during the inspection. This family childcare home operates Monday - Friday 24 hours per day. LPA verified that the licensee's phone number and email address on file are correct. LPA toured the home with Aislinn Martinez, to conduct a health and safety inspection. The home is a single-story home, and consists of 2 bedrooms, 2 bathrooms, living room, kitchen, dining area. LPA observed that the home is neat and clean with heating and ventilation for the safety and comfort of children in care. The on-limit areas include the living room, kitchen, dining area, bathroom to the front of the home and the bedroom in the front of the home. The off-limit areas include the bedroom and bathroom at the rear of the home. These areas are made inaccessible by closed and/or locked doors, gates, and visual supervision. The kitchen table is used for isolation of sick children, away from other children in care. The fireplace in the living room is blocked to prevent access by children during today’s visit. The back yard is used for outdoor play and is fully fenced. LPA did not observe any hazards or dangerous conditions in the yard during today’s visit. LPA observed toys, equipment and activities available for children both indoors and outdoors and observed that they are in good condition during today’s visit. LPA did not observe any bodies of water, toxins, medications or hazardous items that would be accessible to children during today’s visit. The licensees stated that there are no firearms on the premises. The home is equipped with fully charged 2A10BC fire extinguishers, a working carbon monoxide detector in the kitchen, working smoke detector in the front bedroom, working telephone, and first aid kits and supplies. The last documented fire drill was conducted on 5/2023. LPA observed all of the required forms posted. LPA reviewed children's files, staff files and obtained a copy of the current roster.

SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Randall Dunevant
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023

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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: ANDRADA, MIYANI	FACILITY NUMBER: 013423587
	VISIT DATE: 10/05/2023

NARRATIVE

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To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

Licensee was reminded that all adults 18 and over living or working in the home, 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.

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-andresources/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.

LPA reminded the licensees that smoking, baby walkers, bouncers, jumpers and similar items are not allowed in family childcare homes. LPA provided the main office number for the Oakland Regional Child Care office (510) 622-2602 for the licensees to call and report injuries or unusual incidents and reviewed the form to follow up in writing within 7 days of the injury/unusual incident. The licensees were encouraged to periodically review regulations, guidelines and Provider Information Notices (PINs) on the website www.ccld.ca.gov.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. 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 are available at: https://www.ada.gov/resources/child-carecenters/.

SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Randall Dunevant
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023

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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: ANDRADA, MIYANI	FACILITY NUMBER: 013423587
	VISIT DATE: 10/05/2023

NARRATIVE

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Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the LICENSEE, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

LPA reminded the licensee that the mandated reporter training is required for all staff and is to be renewed every 2 years at www.mandatedreporterca.com.

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

A Type A deficiency was cited during this visit. The Licensee acknowledges that for Type A Deficiency only upon receipt, the licensee shall post the LIC 809 with Type A deficiency for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/ guardians of children newly enrolled at the facility during the next 12 months. The LIC 9224 must be signed by parents/ guardians and kept with the children's forms as a receipt whenever any Type A documents are provided by the licensee. A copy of the LIC 9224, and AB 633 fact sheet, was given to licensee at time of this inspection.

Exit interview conducted and report was reviewed with the licensee Miyani Andrada.

SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Randall Dunevant
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/05/2023 11:23 AM - It Cannot Be Edited

Created By: Randall Dunevant On 10/05/2023 at 10:22 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: ANDRADA, MIYANI	FACILITY NUMBER: 013423587
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/05/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

102416.5(d)(1)

Staffing Ratio and Capacity

(d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either: (1) Twelve children, no more than four of whom may be infants; or This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in that the facility had five infants in care during todays inspection which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 10/13/2023
	Plan of Correction
1 2 3 4	Licensee is to reduce the amount of infants to meet ratio and maintain ratio/ capacity specified on license. LPA to revisit to ensure Licensee is remaining within RATIO.

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:

Loretta Dyson

LICENSING EVALUATOR NAME:

Randall Dunevant

LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023

LIC809 (FAS) - (06/04)

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