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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005348
Report Date: 06/26/2019
Date Signed: 06/26/2019 02:56:14 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:DE OLIVEIRA, MARIANGELAFACILITY NUMBER:
214005348
ADMINISTRATOR:DE OLIVEIRA, MARIANGELAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 368-8713
CITY:CORTE MADERASTATE: CAZIP CODE:
94925
CAPACITY:14CENSUS: DATE:
06/26/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:De Oliveira MariangelaTIME COMPLETED:
03:00 PM
NARRATIVE
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Licensing Program Analyst (LPA), Van conducted a POC (Plan of Corrections) inspection and met with licensee De Oliveira Mariangela and her helper Korolayne Gabriela Burig. Present in the facility are 7 children (5 are infants and 2 are preschools age).

The POC was related to the deficiency cited on 5/16/2019. On that day licensee was operated over capacity. LPA and licensee inspected the day care areas. LPA reviewed children's files. In today's inspection licensee is still over capacity. Although some children had left the day care since 5/16/19, there are three new infants recently enrolled in the day care.

A Type “A” violation (see continuation) was issued today. The center is informed to provide a copy of the Evaluation Report and the Type “A” Deficiency cited to the parents and guardians of children currently enrolled in care and to parents of newly enrolled children during the next 12 months. A signed and dated LIC 9224 shall be maintained in all Children's files. This report and appeal rights were provided and reviewed with the licensee. Notice of Site Visit shall remain posted for 30 days.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon VanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2019
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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: DE OLIVEIRA, MARIANGELA
FACILITY NUMBER: 214005348
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/26/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/27/2019
Section Cited
CCR
102416.5(d)(1)
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CCR 102416.5(d)(1) ) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either: Twelve children, no more than four of whom may be infants.
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Repeated deficiency. Facility was operated over capacity on 5/16/19.

By 6/27/2019, Licensee states she will reduce the infant ratio to 4, and will operate within ratio. Licensee states she will send LPA a new children roster. Licensee also states she will come in the office to speak with management about her hardship.
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This requirement is not met as evidenced by LPA observed 5 infants in care. This poses an immediate health and safety risk to children in care.
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San Bruno Child Care Regional Office
851 Traeger Ave #360
San Bruno CA 94066
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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: Brendon VanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2019
LIC809 (FAS) - (06/04)
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