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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004529
Report Date: 06/24/2021
Date Signed: 06/24/2021 05:13:51 PM

Document Has Been Signed on 06/24/2021 05:13 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:BURRELL, AMINA M.FACILITY NUMBER:
414004529
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: DATE:
06/24/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:25 PM
MET WITH:Amina Burrell and Michael BurrellTIME COMPLETED:
03:12 PM
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Licensing Program Analyst (LPA) Tapia-Mandujano, conducted a case Management inspection and met with Licensee’s Husband, Michael Burrell upon arrival. Licensee’s Husband was caring for 9 children (1 infant, 8 preK). Licensee was contacted via phone and said she was returning to the facility. Licensee arrived with an additional 3 children (1 preK, 2 School Age) and her 10 year old minor. Husband’s CPR has since expired. Licensee has a waiver on file per PIN 21-07-CCP (Statewide Waivers to renew Pediatric CPR and First Aid Certifications due to the COVID-19 Public Health emergency). Purpose of the inspection was explained. Licensee has submitted a request for a Large capacity FCCH (Family Child Care Home).
LPA, Husband, and licensee inspected home for Health and Safety Hazards. DAYCARE AREA AREA: Living Room, Bedroom #1, Bedroom #2, and Bedroom # 3, Bathroom #1, Kitchen, Den, and backyard. OFF-LIMIT AREA: Garage/Storage. All off limit areas are properly barricaded. LPA observed the following: home is clean, orderly and equipped with age appropriate toys and equipment for children indoors and outdoors. Outdoor play area is maintained clean and free of debris. LPA reminded Licensee to maintain second exit pathway through the backyard gate clear of any objects.

Capacity limits of a Small and Large License has been reviewed with Licensee.

Prior to continuing process of a large capacity FCCH, License, an office meeting will be held with Licensee.

**See following page for deficiencies cited against the facility today under CCR,Title 22, Div. 12, Chapt. 1

Type “A” violations were issued today. Licensee is advised to provide a copy of the Evaluation Report and all Type “A” Deficiencies cited, to the parents and guardians of children currently enrolled in care and to parents of newly enrolled children during the next 12 months. A signed and dated LIC 9224 shall be maintained in all Children's files. Notice of site Visit was posted and should remain posted for 30 days, failure to post will result in an immediate civil penalty.

**Today’s report dated 06/24/2021, rights to comment and appeal, and Notice of Site visit will be emailed to Licensee at AMINAECOWONDERSCHOOL@GMAIL.COM by close of business today, 06/24/2021.
Confirmation of receipt is required. **
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE: DATE: 06/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/24/2021
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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Document Has Been Signed on 06/24/2021 05:13 PM - It Cannot Be Edited


Created By: Leslit Tapia-Mandujano On 06/24/2021 at 04:39 PM
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
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: BURRELL, AMINA M.
FACILITY NUMBER: 414004529

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/24/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/28/2021
Section Cited
CCR
102416.5(a)

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102416.5(a) Staffing Ratio and Capacity. (a) The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time. This requirement is not met by evidence by:
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Licensee must reduce capacity immediately to a small capacity.
Licensee can have no more than 4 infants (24 months or younger) in care at one time.
OR Licensee can have combination of infants and PreK age (over 24 months), with no more than 3 infants and remaining children of Pre-K age with max capacity of 6-8 children in care at one time.
Child #7 must be enrolled and attending Kindergarten or higher, Child #8 must be enrolled and attending 1st grade or higher
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LPA observed Licensee’s Husband caring for 9 children (1 infant and 8 PreK) upon arrival at the facility. Licensee arrived shortly after with 3 additional children (1 PreK and 2 school age). This poses an immediate Health and Safety risk to children in care.
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Licensee will update facility roster and children's schedule, showing compliance to the capacity requirements as stated on the license. A follow-up inspection will be conducted.
An office meeting will be scheduled at a later time.

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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:Cindy Interiano
LICENSING EVALUATOR NAME:Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE:
DATE: 06/24/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/24/2021


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/24/2021 05:13 PM - It Cannot Be Edited


Created By: Leslit Tapia-Mandujano On 06/24/2021 at 04:47 PM
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
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: BURRELL, AMINA M.
FACILITY NUMBER: 414004529

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/24/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/02/2021
Section Cited
CCR
102416(c)

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102416(c) Personnel Requirements
The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.
This requirement is not met as evidenced by:
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Licensee’s Husband must schedule a CPR renewal class if he will continue to be left alone with the children.
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Licensee’s Husband CPR has since expired and he was left alone with 9 children. This poses a potential health and safety risk to children in care.
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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:Cindy Interiano
LICENSING EVALUATOR NAME:Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE:
DATE: 06/24/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/24/2021


LIC809 (FAS) - (06/04)
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