013421857-11-12-2021-52-CC-MPRE-C8Q2HK-20211112162453

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013421857
Report Date: 11/12/2021
Date Signed: 11/12/2021 04:25:06 PM

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:	QUIHUIS, GEORGIANNA		FACILITY NUMBER:	013421857
ADMINISTRATOR:	QUIHUIS, GEORGIANNA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 750-1932
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94542
CAPACITY:	14	CENSUS: 7	DATE:	11/12/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:25 PM
MET WITH:	Georgianna Quihuis		TIME COMPLETED:	04:27 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 11/12/2021 at 2:25pm Licensing Program Analyst (LPA) Morgan Pringle met with Licensee Georgianna Quihuis for an Unannounced Annual Inspection. Present during the inspection was the Licensee and her fingerprint cleared daughter N. Quihuis. There were two infants (2), three (3) preschool children and two (2) school age children present during the inspection. Licensee’s home was toured for a health and safety inspection. The facility operates 7:00am – 6:00pm, Monday - Friday. ON LIMITS AREA: Living Room, Playroom, Kitchen (eating only), Bathroom across from the kitchen and Backyard OFF LIMITS AREA: Three (3) bedrooms, Hallway Bathroom and Garage ISOLATION AREA: Living Room or Playroom The facility is a single-story home rented by the Licensee. The inside and outside of the home is observed to be neat and clean with ample age appropriate materials for the children. All toxins, cleaning products, and hazardous materials were observed to be in inaccessible areas. There is a open shed in the backyard, per licensee, the children do not play on that side of the home and the shed will be closed and locked when children return to play outside. The home has one (1) fully charged 3A40BC fire extinguisher in the kitchen. There is one (1) working smoke detector in the playroom and another in the hallway. There is a carbon monoxide detector in the hallway as well. The home is equipped with many windows and portable fans for proper ventilation. The fireplace in the living room is blocked by furniture and made inaccessible to children in care. The wall heater in the living room is fully enclosed with a wooden barricade and turned off. LPA did not observe any bodies of water in or around the home that could be a potential danger to the children in care. Licensee stated that there are no firearms and no pets in the home. Continued on LIC809-C

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan Pringle	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021

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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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: QUIHUIS, GEORGIANNA	FACILITY NUMBER: 013421857
	VISIT DATE: 11/12/2021

NARRATIVE

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The Licensee’s Health and Safety training has been completed and CPR and First Aid training is complete with an expiration date of 3/2022. Licensee Mandated Reporter training is valid and expires on 7/7/2023. All required forms are posted and visible for public view in the playroom. LPA obtained the children’s files and the facility roster. LPA observed all children were missing LIC9150 (see LIC9102TA). LPA also observed both infants in care were missing an Individual Infant Sleeping Plan, LIC9227 (see LIC9102TA). LPA obtained the fire/disaster drill log. Log is complete with the last drill logged 7/6/2021.

Licensee was reminded that California Law requires licensees to report unusual incidents or injuries to children in care, to child's parents, and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or email. LPA informed Licensee that all forms can be downloaded at www.ccld.ca.gov. Licensee was also informed that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every two (2) years by visiting http://www.mandatedreporterca.com.

Licensee was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Children’s Roster must be properly maintained, and fire/disaster drill must be conducted every six (6) months and documented. The licensee is reminded that any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm.

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.
Continued on LIC809-C

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan Pringle	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021

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: QUIHUIS, GEORGIANNA	FACILITY NUMBER: 013421857
	VISIT DATE: 11/12/2021

NARRATIVE

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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.

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.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Georgianna Quihuis.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan Pringle	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021

LIC809 (FAS) - (06/04)

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