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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005444
Report Date: 06/18/2021
Date Signed: 06/21/2021 10:14:27 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:MUNOZ, VICTORIA AND GARAY, JUANFACILITY NUMBER:
214005444
ADMINISTRATOR:MUNOZ, VICTORIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 455-9621
CITY:SAN RAFAELSTATE: CAZIP CODE:
94901
CAPACITY:14CENSUS: 11DATE:
06/18/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Victoria MunozTIME COMPLETED:
05:20 PM
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*** This report was prepared in CCLD Regional Office, San Bruno due to COVID-19. Facility inspection was conducted on 6/18/21. Victoria was informed that a copy of this report will be emailed to her by close of business on Monday 6/21/21***

Licensing Program Analyst (LPA), Farhan Bashir-Tariq arrived at the facility above unannounced and met with Licensee, Victoria Munoz, for a required one-year visit. Purpose of inspection was explained. There were 11 children present with Licensee and a helper, Iris Munoz. Licensee is operating within the capacity and is following staff child ratio on this day. LPA verified the background check clearance of all adults living or working in the home. Prior to this on-site inspection, risk assessment was completed with Victoria to identify any COVID risks. No risks were identified. LPA and Licensee inspected the entire day care area 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 available in the home. LPA performed the tests to check the functionality of the detectors. 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 and no pets in the home. LPA observed that the house is in good repair and free of hazards with proper temperature and ventilation. 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. Per Licensee, Discipline policy is redirection or communication. LPA reviewed facility records including 6 random children. LPA observed that files have records of immunization, names, addresses and telephone numbers of each child's authorized representative. Licensee has a valid and current CPR and First Aid card expiring in January 2023. LPA encouraged the facility 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.

>No deficiencies were cited today under Title 22 Division 12 of the California 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 shall be posted for 30 days from the date of visit.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Farhan Bashir-TariqTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2021
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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