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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015701156
Report Date: 09/09/2024
Date Signed: 09/09/2024 09:38:43 AM

Document Has Been Signed on 09/09/2024 09:38 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:ZUNIGA, MYRIAM & HENRIQUEZ, MIGUELFACILITY NUMBER:
015701156
ADMINISTRATOR/
DIRECTOR:		ZUNIGA, MYRIAMFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 303-1057
CITY:HAYWARDSTATE: CAZIP CODE:
94545
CAPACITY: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 0DATE:
09/09/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Myriam Zuniga & Miguel HanriquezTIME VISIT/
INSPECTION COMPLETED:
09:33 AM
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On 9/9/2024 at 8:00am Licensing Program Analyst (LPA) Morgan Pringle and met with Applicants Myriam Zuniga and Miguel Henriquez for an Announced Pre-Licensing Inspection for a Change of Location. Present during the inspection were the Applicants. Applicants live in the home with their adult daughter who will serve as their assistant. Applicants’ home was toured for a health and safety inspection. The facility plans to operate 7:00am – 6:00pm, Monday - Friday.

ON LIMITS AREA: Living Room, Kitchen, Dining Area, Two (2) bedrooms on the left side of the hallway, Hallway Bathroom, and Backyard
OFF LIMITS AREA: Primary bedroom and attached bathroom and Garage
ISOLATION AREA: First bedroom room on the left side of the hallway or living room

The facility is a single-story home rented by the Applicants. The home consists of three (3) bedrooms, two (2) bathrooms, living room, kitchen, dining area, garage (attached to the home with no direct access to the home), and backyard.

The inside of the home was observed to be neat, clean with ample age-appropriate materials for the children’s learning and play. All toxins, cleaning products, and hazardous materials have been made inaccessible to the children. All off-limit areas in the home have been made inaccessible with closed doors and locks. The home has centralized heat and air for proper ventilation. Applicants stated that all children’s bedding will be brought from the child’s home, and Applicants will provide sleeping cots. Applicants stated they will be providing all meals and snacks for the children. Applicants will be providing transportation as well. LPA has verified that the vehicle used for transportation has current insurance and registration. There is a 3A40BC fire extinguisher by the desk in the living room.
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SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE: DATE: 09/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/09/2024
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 STE 1102
OAKLAND, CA 94612
FACILITY NAME: ZUNIGA, MYRIAM & HENRIQUEZ, MIGUEL
FACILITY NUMBER: 015701156
VISIT DATE: 09/09/2024
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There is one (1) working smoke/carbon monoxide detector in the kitchen and the hallway. There is a working smoke detector in all bedrooms all well. Applicants stated there are no firearms and one cat in the home.

The backyard is fully fenced with ample space for the children to play. There is an awning and canopy for extra shade and a large storage shed that was observed to be locked and inaccessible to the children in care. LPA did not observe any harmful bodies of water in or around the home.

This home was granted a fire clearance on 9/3/2024 from the Hayward Fire Department.

The Applicants Health and Safety training's have been completed and Pediatric CPR and First Aid certificates are current and expire 10/27/2024 and 7/16/2025. Applicants Mandated Reporter training's are complete and expire on 8/26/2026. All required posting are made visible by the front door. All adults living in the home have obtained a criminal record clearance.

Applicants were reminded that California law requires Licensees to report unusual incidents and/or injuries to children in care, to the child's parents, and to Community Care Licensing Division (CCLD) within 24 hours by phone. Within seven (7) days from the incident, Licensees must submit the Unusual Incident/Injury form (LIC 624B) to CCLD. Applicants was reminded that any structural changes or additions to the home must be reported to CCLD as well. Children’s Roster must be properly maintained, and fire/disaster drills must be conducted every six (6) months and documented. Applicants was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Applicants was also informed that Mandated Reporter Training ("Child Care Providers") is required for all staff and is to be renewed every two (2) years by visiting https://mandatedreporterca.com/. LPA informed Applicants that all forms can be downloaded at www.ccld.ca.gov.



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SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2024
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 STE 1102
OAKLAND, CA 94612
FACILITY NAME: ZUNIGA, MYRIAM & HENRIQUEZ, MIGUEL
FACILITY NUMBER: 015701156
VISIT DATE: 09/09/2024
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Applicants 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, 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 Applicants 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 Applicants 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.

On this date, 7/25/2024 the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

LPA has verified that all requirements have been met during this inspection and a license for a large family child care home is approved today, 9/9/2024.

Exit interview conducted and report was reviewed with the Applicants, Myriam Zuniga and Miguel Henriquez.


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SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2024
LIC809 (FAS) - (06/04)
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