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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409081
Report Date: 07/21/2023
Date Signed: 07/21/2023 12:42:36 PM

Document Has Been Signed on 07/21/2023 12:42 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:MORENO, ANAFACILITY NUMBER:
073409081
ADMINISTRATOR:MORENO, ANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 756-2287
CITY:ANTIOCHSTATE: CAZIP CODE:
94509
CAPACITY: 14TOTAL ENROLLED CHILDREN: 4CENSUS: 1DATE:
07/21/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Ana MorenoTIME COMPLETED:
12:30 PM
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On 07/21/2023 at 8:55 AM, Licensing Program Analyst (LPA) Christina Watts conducted an unannounced annual inspection for Ana Moreno's large family child care home. LPA met with licensee and guided analyst on a tour of the facility. During today's inspection, there were 1 children in care (1 preschool aged child) and 4 children enrolled. Also present during inspection was aide, licensee's brother and sister in law, licensee's 3 minor relatives, licensee's foster child age 4 months and licensee's minor children 11, 11, 10 and 9 years old. Family members residing in the home are licensee, licensee's 4 minor children ages 11, 11, 10 and 9 years old, licensee's foster child age 4 months, licensee's brother and sister in law, licensee's minor relatives ages 16, 13 and 5 years old, and licensee's adult relative who is also an aide for the facility. Licensee and aide have current Criminal Record Clearance. Facility hours of operations are Monday - Friday 7:00 AM - 5:30 PM.

This is a two story home which consists of 5 bedrooms, 3 bathrooms, kitchen, dining room, living room, family room, laundry room, attached garage that is converted to a living space, backyard with a shed and hot tub..
The children on limits areas: Family Room, Kitchen, First Floor Bathroom, Backyard,
Areas off limits include: All 5 bedrooms, 2 bathrooms, Living Room, Laundry Room, and Converted Garage.
The LPA toured all areas used by children during this visit. LPA reminded licensee that living room is only to be walked through to get the the family room and cannot be use for daycare.

Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and central heating system for safety and comfort. There were safe toys, play equipment and materials observed for children. There are stairs in the home that are made inaccessible for children in care. There is a working telephone in the home. Detergents, poisons, cleaning compounds, medications, and other items which can pose a danger to children are made inaccessible in the home.

*CON'T ON PAGE 2*

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE: DATE: 07/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/21/2023
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 5
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: MORENO, ANA
FACILITY NUMBER: 073409081
VISIT DATE: 07/21/2023
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*PAGE 2*

Per licensee, there are no weapons or firearms in the home. Licensee has an up to code 2A10BC fire extinguisher and working smoke/carbon monoxide detector on the premises. LPA observed a screened fireplace in the living room. Licensee last conducted fire drill 02/2023. Licensee stated there are no pets in the home.

LPA inspected the backyard and observed a fully fenced and safe backyard for children. LPA also observed age appropriate toys for children to play with. LPA observed a hot tub located in the backyard that has a cover that can withstand the weight of an adult and has locks on all 4 sides. LPA discussed with licensee that there needs to be 100% supervision when children are playing in the backyard due to the steep hill and retaining wall. Facility does not provide transportation for children, but understands that children cannot be left alone, unattended in parked vehicles.

Children’s records were reviewed to ensure that each child has an Identification and Emergency form. The licensee Pediatric First Aid and CPR certificate will expire in 08/2024. Required postings were observed near the entrance.

LPA reminded licensee day care needs to be operated within the limitations and capacity of a Large Family Child Care Home with regards to ratios and that Licensee has to be present in the day care for 80% of the operation hours.


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.

*CON'T ON PAGE 3*

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2023
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: MORENO, ANA
FACILITY NUMBER: 073409081
VISIT DATE: 07/21/2023
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*PAGE 3*

This facility provides Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes 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

On or before March 30, 2018, any person who works in a child care facility shall complete Mandated Reporter training and renew the training every 2 years. Website provided: https://www.mandatedreporterca.com/training/child-care-providers. Licensee's Mandated Reporter certificate is currently expired. Licensee stated they were unaware they had to renew the Mandated Reporter certificate every two years. LPA informed licensee the requirements for Mandated Reporter training. Licensee stated she will complete training and once completed, will submit certificate to licensing.

Licensee 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.

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/process

In the areas that were evaluated, there were no violation observed.

Exit interview conducted and report was reviewed with the licensee, Ana Moreno. A notice of site visit was given and must remain posted for 30 consecutive days.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2023
LIC809 (FAS) - (06/04)
Page: 3 of 5