214005507-9-3-2019-05-CC-LGOZ-BFNTLG-20190903144931

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 214005507
Report Date: 09/03/2019
Date Signed: 09/03/2019 02:49:41 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:	CANALES, EVELYN A.		FACILITY NUMBER:	214005507
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 1	DATE:	09/03/2019
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Licnesee, Evelyn Canales		TIME COMPLETED:	03:00 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 applicant, Evelyn Canales, for a scheduled change of location pre-licensing inspection at the facility. Previous license #214005279. Present is licensee and her son (School age). Licensee lives in 2- story Townhouse with 8 children. All the adults living in the house has criminal background clearance on file. Child care will be provided in the primarily in Living Room. Day care areas: Living Room, Dining Room, Bathroom #1 and Patio. Off limit areas: Kitchen, Bedroom #1, Bedroom #2, Bedroom #3 and Bathroom #2. All off limits areas must be made inaccessible to children. Isolation of an ill child will be Living Room. Licensee was notified that prior to use of any off limits area, the department must be notified. LPA Gomez inspected the entire home with the applicant for health and safety hazards. The house has proper temperature and ventilation. All the toxins or dangerous materials are stored in off limit areas, under the kitchen sink. There is no fireplace in the day care area. Stairs are barricaded with a child safe gate. The home has a working telephone, fully charged 2A10BC fire extinguisher, smoke detector and carbon monoxide detector. There is first aid kit available in bathroom #1. There is a variety of age appropriate toys and materials available. All sharp corners of walls and furniture are covered with child safe padding. All unused electrical outlets are properly covered. Licensee stated that discipline policy will be timeouts. Applicant was informed that time outs cannot be any longer than one minute per age of the child and cannot exceed five minutes. Licensee is informed that all adults, 18 years and older living in the home, helper or assistant must have criminal record clearance and must be associated to the facility by submitting an LIC 9182 with copy of CA DL or CA ID prior to having any contact with children in care. Failure to do so could result in an immediate civil penalty of $100.00 each day. See next page for continuation…

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8832
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 393-9134
LICENSING EVALUATOR SIGNATURE:	DATE: 09/03/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2019

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 2

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: CANALES, EVELYN A.	FACILITY NUMBER: 214005507
	VISIT DATE: 09/03/2019

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

…Continuation from previous page
Licensee has submitted the copy of valid CPR/ 1st aid certification until May, 2020. LPA discuss licensing regulations and capacity requirements and a capacity worksheet was provided. Licensing forms and posting requirements were reviewed with the applicant. Food brought from home should be properly labeled. Licensee understands that fire/earthquake drills are to be conducted every 6 months and recorded. Licensee understands that baby walkers, bouncers, and excersaucers are not allowed. Smoking is prohibited in family child care homes. Any children under 10 years of age will be counted in capacity. Licensee was informed about the Provider Information Notices (PINs) on CCLD website. Safe sleep handout was discussed and provided as a resource. Licensee is aware that all adults providing care and supervision must be immunized against measles, pertussis and influenza.

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

The applicant is encouraged to frequently visit out website at www.ccld.ca.gov for licensing regulations and new updates. Applicant can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

Prior to recommendation for issue licensure, Applicant needs to complete the following:

- Submit copy of Licensee’s current rental agreement

Copy of this report was reviewed and provided to applicant. This report will be kept in the facility file and will be made available for public review upon request. Desk Duty is available Monday through Friday between 8 AM - 5 PM at (650) 266-8800.

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8832
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 393-9134
LICENSING EVALUATOR SIGNATURE:	DATE: 09/03/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2019

LIC809 (FAS) - (06/04)

Page: 2 of 2