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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422739
Report Date: 02/04/2022
Date Signed: 02/04/2022 12:57:14 PM

Document Has Been Signed on 02/04/2022 12:57 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:MIROV, CHRISTINEFACILITY NUMBER:
013422739
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 7CENSUS: 5DATE:
02/04/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Christine MirovTIME COMPLETED:
12:50 PM
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On 2/04/2022 at 10:00AM, Licensing Program Analyst (LPA) Catherine Fernandes conducted an announced Annual Inspection in conjunction with an increase in capacity inspection with Licensee Christine Mirov. Residing in the home is the Licensee, her finger print cleared husband and her two underage children. The licensee one infant, four preschoolers and two fingerprint cleared assistants were present during the inspection. Todays visit is to conduct a health and safety inspection. Operating hours will be 8:30AM to 2:00PM, Monday through Friday. The entrance to the day care is the gate on the right side of the home that leads to the backyard.

The home is a two story house that consists of 3 bedrooms and 4 bathrooms including the bathroom in the outdoor cottage. The OFF LIMIT AREAS are the entire second floor, the loft area of the cottage and the left side of the backyard, which will be inaccessible by closed and/or locked doors or visual supervision. The ON LIMIT AREAS are the living room, the dining room, the downstairs bathroom, the downstairs bedroom, the kitchen, the breakfast nook area, the lower part of the outside cottage, the back patio area and the fenced in backyard. The ISOLATION AREA will be the couch in the living room next to the front entrance of the home. The outdoor play area will be in the two fenced in areas of backyard. There are toys and play equipment for the children that appear to be safe and in good repair. There are no pools, hot tubs or any other bodies of water during today's inspection. Licensee has four chickens in the backyard, a bunny and a cat on the property.
The home has two a fully charged 3A40BC fire extinguishers and multiple pull down fire alarms throughout the home, a working smoke/ carbon monoxide detectors throughout the home. Licensee has a working telephone and complete First Aid Kit. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on 9/10/2021. The Licensee's CPR and First Aid certificate is current and expires on 8/2022. There is a fire place in the dining room that is only decorative and is flat on the ground. There are gates placed where the there are stairs in the home.
REPORT CONTINUES ON LIC 809C
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE: DATE: 02/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/04/2022
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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: MIROV, CHRISTINE
FACILITY NUMBER: 013422739
VISIT DATE: 02/04/2022
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Per Licensee, there are no firearms in the home. The Licensee was reminded of the responsibility as a mandated reporter and has provided proof of the required training for child care providers, which has been completed on 01/6/2022. The licensee has provided proof of the Lead Safety training for Child Care Providers which was completed on 10/06/2020. Five of the five children's files were reviewed and complete.
On 01/07/22, a fire clearance was granted to facility by the Oakland Fire Department. All documents have been reviewed for the increase of capacity application. The Licensee was reminded that an assistant is needed with a large family child care home license, and whenever an assistant is not present, the licensee will comply with the capacity requirements for a small family child care home.
Incidental Medical Services (IMS) policy was discussed and Licensee is not providing IMS as of today.

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 [email protected]. 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

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

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep web page 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.

As of 02/04/2022, this home is recommended for an increase of capacity.

A notice of site visit was given and must remain posted for 30 days
Exit interview conducted and report was reviewed with the licensee
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2022
LIC809 (FAS) - (06/04)
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