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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005289
Report Date: 03/06/2020
Date Signed: 03/09/2020 09:40:01 AM

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:BLUNCK-RIBEIRO, ISABELLAFACILITY NUMBER:
214005289
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: DATE:
03/06/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Andre Riberio & Isabella Blunck-RiberioTIME COMPLETED:
01:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Farhan Bashir-Tariq arrived at the facility above unannounced to conduct a required Inspection on this day and met with licensee’s husband. Licensee was out for an appointment but arrived later on during the inspection . Purpose of the inspection was explained. Present there were 6 children (3 infants and 3 pre-k) in care with two helpers. Licensee was operating in compliance to the required licensed capacity and ratio limits as of today. LPA verified the background check clearance of the adults working or living in the home. Hours of operating are: M-F, 7:30 AM -5:30 PM. Licensee provides breakfast, lunch and two snacks to children in care.

Licensee rents home, which is a 3-bedroom, 2 bathrooms, 2- level house. Day-care areas are: Living Room, Bedroom #2- and Lower-Yard Area. Off Limit areas are: Kitchen, Bedroom #1, Entire Upstairs, (Bedroom #3 and Bathroom #2) and Deck Area ( Pass through only). All off limit areas are properly barricaded. LPA and Licensee's husband toured the day care areas for Health and Safety hazards. LPA observed that off limit areas were properly barricaded and made inaccessible to the children in care. There was a Carbon monoxide detector and a Smoke detector in the home. A Fire Extinguisher of size 2A10BC or bigger and a working telephone was also available in the home. First Aid kit is fully stocked and accessible. Per Licensee, there are no firearms or weapons in the home. Licensee states, there are no bodies of water in the home. Licensee has two dogs in the home, which are kept on off-limits area during the day care hours. Immunization records for dogs are current.



LPA observed that the house is in good repair and free of hazards with proper temperature and ventilation. Poisons, chemicals and detergents are stored inaccessible to children in care. LPA observed that there is a variety of age appropriate toys, books and other learning material available in the home for the children in care. Electric outlets, in the day care are, have been secured with child protective covers.
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SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Farhan Bashir-TariqTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2020
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 3
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: BLUNCK-RIBEIRO, ISABELLA
FACILITY NUMBER: 214005289
VISIT DATE: 03/06/2020
NARRATIVE
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Licensee presented a copy of children’s roster for reviewing and collection. All posting requirements are met and posted near the main entrance. Licensee and helper have current and valid CPR and First Aid cards expiring in June 2021 and June 2020 respectively. LPA also reviewed Licensee’s, immunization records and facility fire drill log. Per Log, last drill was conducted on November 7, 2019. Licensee is aware of the requirement of conducting and logging fire drills once every six months. LPA reviewed facility records including all present children's and staff's files. LPA observed that files have records of immunization, names, addresses and telephone numbers of each child's authorized representative.

LPA reminded Licensee that All adults, 18 years and older living in the home, helper, or assistant must have finger print clearance and must be associated to the facility by submitting an LIC 9182 with a copy of CDL or CA. ID prior to having any contact with children in care, failure to do so could result in an immediate civil penalty.

LPA reminded Licensee that as of September 1, 2016, a person may not be employed or volunteer at a childcare facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.


LPA reminded Licensee that As of January 1, 2018, all staff is required to complete Mandated Child Abuse Reporter Training (AB1207) every two years. The training can be obtained online at www.mandatedreporterca.com. LPA observed training completion certificates for both licensee and helper present today. LPA encouraged the Licensee to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. Facility can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

> Type A deficiency was cited today under Title 22 Division 12 of the California Code of Regulations. See LIC 809D. 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 shall be posted for 30 days from today's visit. Licensee was advised for any additional questions to call Office, M-F, 8AM-5PM at 650-266-8800. For Rules and Regulations, visit the Website: www.cdss.ca.gov

SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Farhan Bashir-TariqTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2020
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: BLUNCK-RIBEIRO, ISABELLA
FACILITY NUMBER: 214005289
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/06/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/09/2020
Section Cited

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102370(d)(1) Criminal Record Clearance. All individuals are subject to criminal record review as specified in section 1596.871 prior to working, residing or volunteering in a licensed home, shall obtain a California clearance or criminal record exemption as required by the department.
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The requirement is not met as evidenced by records review.
LPA observed that one of the helpers in daycare was interacting with children in care without required fingerprint clearance.
This poses an immediate 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: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Farhan Bashir-TariqTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 03/06/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/06/2020
LIC809 (FAS) - (06/04)
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