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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414005025
Report Date: 08/20/2024
Date Signed: 08/20/2024 12:26:01 PM

Document Has Been Signed on 08/20/2024 12:26 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:MERIDA, HEALYN A.FACILITY NUMBER:
414005025
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 7DATE:
08/20/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Licensee Healyn A. MeridaTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
NARRATIVE
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On August 20, 2024 at approximately 9:15am, Licensing Program Analyst’s (LPA) Melissa Zaragoza conducted an unannounced, annual inspection. LPA was greeted and granted access by licensee, Healyn A. Merida. At the entrance licensee was explained the purpose of the inspection. Present during LPA's visit included Licensee, 1 staff, and 7 children (4 infants, 2 preschool ages, and 1 school age).

Hours of operation are Monday through Friday. 8:00am to 5:30pm. Licensee lives in a one-level home with their 2 children. All adults living in the home and staff present, have fingerprint clearance on file.

The DAY CARE AREAS are the living room, dining room, bathroom #1, bedroom #1 (napping room), and backyard. The OFF LIMIT AREAS are the kitchen, garage, bedroom #2, bedroom #3, bathroom #2. Off limit areas are made inaccessible with child safety gates.

LPA toured day care areas of home with licensee. LPA observed home to be in good repair with proper temperature and ventilation. Home is equipped with a variety of toys and materials that were observed to be in good condition. LPA observed electrical outlets to be made inaccessible with child safety covers. Cleaning supplies, poisons and hazardous materials are stored in home's high shelves and/or locked behind child safety locked cabinets.

Home is equipped with a fully charged fire extinguisher and a smoke and carbon monoxide detector. Smoke and carbon monoxide detector were tested during the visit and was observed to be in working condition. There are no pools, and bodies of water in the premises.

Napping room (bedroom#1) was observed to be equipped with cots and playpens for napping children. Playpens were observed to be free of loose articles, bumper pads and pillows. LPAs observed Playpens to have mattresses with tight fitting sheets. Sleeping logs for napping infants are maintained and includes the 15 minute time check of when infant was last checked on and sleeping position.


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SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE: DATE: 08/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/20/2024
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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Document Has Been Signed on 08/20/2024 12:26 PM - It Cannot Be Edited


Created By: Melissa Zaragoza On 08/20/2024 at 11:24 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
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: MERIDA, HEALYN A.
FACILITY NUMBER: 414005025

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/20/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102416.5(b)(2)
Staffing Ratio and Capacity
(b) For a Small Family Child Care Home, the maximum number of children for whom care may be provided at any one time, including children under age 10 who reside at the licensee's home, shall be one of the following: (2) Six children, no more than three of whom may be infants; or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above and was operating over capacity. 4 out of 7 children were infants which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/21/2024
Plan of Correction
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Licensee will asure they are operating within capacity. Licensee will inform parents they can no longer provide care for some children. Licensee will submit proof to LPA they are not over capcity by showing updated facility roaster.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Marie Rodriguez
LICENSING EVALUATOR NAME:Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE:
DATE: 08/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/20/2024


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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: MERIDA, HEALYN A.
FACILITY NUMBER: 414005025
VISIT DATE: 08/20/2024
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Bathroom was observed to be in proper working condition. There is appropriate sanitation and toileting equipment for children in care. LPA observed children’s diapers and wipes in the living room to be properly labeled with each child’s individual names. Per licensee, children’s families provide diapers and wipes for enrolled children.

Children eat in dining area. A food service is provided to children that includes breakfast and snacks. LPA observed eating area to be clean and equipped with appropriate dining furniture. LPA observed knives to be made inaccessible in off limit area.

Outdoor area is entirely enclosed and fenced. Outdoor area includes a variety of toys and equipment that were in good condition. LPAs observed outdoor area to have fake grass and cushion flooring. LPA observed natural lighting from the trees for shade. LPA did not observe any pools, spas or bodies of water on site.

LPA reviewed 6 random children's records which were complete. LPA reviewed licensee and staff who were present records, which were complete. Licensee has a current CPR/First Aid certification and current Mandated Reporter certification. Licensee's CPR/First Aid certification will expire on 6/2025 and Mandated Reporter certifications will expire 6/15/2025.

Emergency disaster drills are conducted and are appropriately documented. Disaster drills are conducted monthly. LPA observed licensing documentation to be properly posted, made available for review. Facility maintains a childcare roster that was also made available for review. Per licensee, there are no weapons or firearms in the home.

There is one deficiency sited during today’s inspection. Per California Code of Regulations, Staffing Ratio and Capacity 102416.5 (Title 22, division 12 & Chapter 1) (b)(2) One-Type A citation.

LPA Zaragoza informed Licensee, Merida A. Healyn that this report dated 08/20/2024 document(s) (1) Type A citation(s) which shall be posted for 30 consecutive days as there is immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Zaragoza informed the licensee to provide a copy of this licensing report dated 08/20/2024 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.



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SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/0202
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024
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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: MERIDA, HEALYN A.
FACILITY NUMBER: 414005025
VISIT DATE: 08/20/2024
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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 athttps://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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

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

During the exit interview, the licensee, Healyn A. Merida, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed a Megan’s Law search on 8/19/24.

Based on interviews, observations and record review, the licensee did not comply with California Code of Regulations Title 22 102416.5(b)(1). The licensee is being cited 1 Type A violation. See attached 809D

Exit interview conducted and report was reviewed with the licensee, Healyn A. Merida.

A notice of site visit was given and must remain posted for 30 days. Licensee was provided with appeal rights.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024
LIC809 (FAS) - (06/04)
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