<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005224
Report Date: 06/06/2019
Date Signed: 06/06/2019 03:13:35 PM

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:SANTIZO, RINA & ALVAREZ, JUANFACILITY NUMBER:
214005224
ADMINISTRATOR:SANTIZO,RINA&ALVAREZ,JUANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 456-0623
CITY:SAN RAFAELSTATE: CAZIP CODE:
94901
CAPACITY:14CENSUS: 8DATE:
06/06/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Licensee, Juan Alvarez and Rina SantizoTIME COMPLETED:
03:30 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
Licensing Program Analyst (LPA), Luis J. Gomez met with Licensee, Juan Alvarez and Rina Santizo. Purpose of the inspection was explained and was for an Annual/Random inspection. Present in the facility is both Licensees caring for 8 children. (2 Infants 6 PreK). Licensee is within capacity limits of the License. Licensee’s home is a 4 bedroom, 3 and a half bathroom, 2-level house. Hours of Operation are: Mon- Sun 6:30am- 8:00pm Daycare areas are: Living Room, Family Room, Dining Room, Half Bathroom and Yard Area. Off Limit areas are: Bedroom #1, Laundry Room (Pass through only), Kitchen (Pass through only) and Entire Upstairs Area (Bedroom #2, Bedroom #3, Bedroom #4, Bathroom #1, Bathroom #2, Bathroom #3 and staircase. All off limit areas are properly barricaded with wooden, child-safe fencing. LPA observed the following: Daycare area is clean, orderly, and equipped with age appropriate toys, blocks and equipment for the children. Home has ample lighting and ventilation. Home has a telephone, a working smoke and carbon monoxide detector, and a fully charged fire extinguisher. There are no poisons, detergents, cleaning products, or sharp objects accessible to the daycare children. Licensee states there are no guns or weapons in the home. Licensee’s cardiopulmonary resuscitation certifications expires: 3/2020. Licensee stated they provides all daily snacks and meals for children in care. All required postings are properly posted next to the main door. LPA observed licensee is not conducting and recording an emergency disaster drills every 6 months.

LPA observed licensee has a pet dog in the home. Licensee stated pet has been properly vaccinated. LPA reviewed children’s files and roster during today’s inspection. LPA observed facility is missing an updated children’s roster. LPA observed facility is missing immunization's records for 6 children in care.

Continue to page 2...
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8832
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 393-9134
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2019
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 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SANTIZO, RINA & ALVAREZ, JUAN
FACILITY NUMBER: 214005224
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/06/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/13/2019
Section Cited
CCR
102417(g)(9)(A)(1)
1
2
3
4
5
6
7
102417(g)(9)(A)(1) Operation of a Family Child Care Home. All homes shall conduct fire and disaster drill at least once every six months and document the date and time of each drill.
1
2
3
4
5
6
7
Licensee will conduct and record an emergency disaster drill by the due date: 6/13/19.

Licensee will provide proof of performed drill to licensing.
8
9
10
11
12
13
14
This requirement is not met as evidenced by LPA observed licensee is not conducting and recording an emergency disaster drills every 6 months. This is a potential health and safety risk to children in care.
8
9
10
11
12
13
14
Type B
06/27/2019
Section Cited
CCR
102418(g)
1
2
3
4
5
6
7
102418(g) Immunization. Licensee should document and maintain each child's immunization as long as the child is enrolled.

1
2
3
4
5
6
7
Licensee will have immunization records for all 6 children in the children's files by the due date: 6/27/19

Licensee will submit proof of correction to licensing.
8
9
10
11
12
13
14
This requirement is not met as evidenced by LPA observed facility is missing immunization's records for 6 children in care. This is a potential health and safety risk for children in care.
8
9
10
11
12
13
14
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: Alma MaligTELEPHONE: (650) 266-8832
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 393-9134
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: SANTIZO, RINA & ALVAREZ, JUAN
FACILITY NUMBER: 214005224
VISIT DATE: 06/06/2019
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
26
27
28
29
30
31
32
Page 2. . .
During inspection,
*Incidental Medical Services (IMS) policy was discussed.
*Licensee was reminded about having all Staff and Volunteers provide proof of immunization against influenza, pertussis, and measles or qualifies for an exemption.
*Licensee was reminded about the Provider Information Notices (PINs) on CCLD website.
*Licensee was reminded about Mandated Reporter Training available on CCLD website (www.ccld.ca.gov or www.mandatedreporterca.com)
*Licensee was given information regarding ‘Safe Sleep’ practices.

>See attached deficiencies page for deficiencies issued today under Title 22 Division 12 of the Ca. Code of Regulations.

>This report and rights to comment and appeal were discussed with Licensee. This report must be available in the facility for public review. Notice of site visit was observed being posted.
Licensee was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.cdss.ca.gov
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8832
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 393-9134
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SANTIZO, RINA & ALVAREZ, JUAN
FACILITY NUMBER: 214005224
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/06/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/13/2019
Section Cited
CCR
102417(g)(8)
1
2
3
4
5
6
7
102417 Operation of a Family Child Care Home. All homes shall have current roster of the children.
1
2
3
4
5
6
7
Licensee will have an updated children's roster at the facility by the due date: 6/13/19.

Licensee will submit proof of correction to licensing.
8
9
10
11
12
13
14
This requirement is not met as evidenced by LPA observed facility is missing an updated children’s roster. This is potential health and safety hazard to children in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Alma MaligTELEPHONE: (650) 266-8832
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 393-9134
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4