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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005509
Report Date: 11/10/2021
Date Signed: 11/10/2021 02:20:16 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:PAZ, NAYARA O.P. AND RONCATO, BRUNO R.FACILITY NUMBER:
214005509
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 8DATE:
11/10/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Nayara Paz, Bruno RoncatoTIME COMPLETED:
02:30 PM
NARRATIVE
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On 11/10/2021 at 10:20A.M. Licensing Program Analyst (LPA), Luis J. Gomez met with Licensee, Nayara Paz and Bruno Roncato. Purpose of the inspection was explained and is for an unannounced Annual/Random inspection. Present was both licensee’s and helper caring for eight children. Licensee’s home is a two bedroom, two bathroom, one story house. Days and Hours of operations are: Monday – Friday, 8:00 A.M., to 5:30 P.M. Day-care Areas: Family Room (playroom), Bedroom #1, Bathroom #1, Backyard and Patio. Off-limit Area: Living room, Kitchen, Dining Room, Bedroom #2, Master Bedroom, Bathroom #2 and Garage. LPA inspected home inside and outside, with the licensee for health and safety hazards.

At 10:25A.M., LPA observed the following: Day-care was clean, orderly with variety of age appropriate books, blocks and games for the children. Furniture and playthings inspected were in good repair. Individual cubbies are located in playroom for children’s belongings. LPA observed child size tables and chairs for snack and activities. Floor in playroom has been covered with padding for added safety. For nap time, infant playpens are located in bedroom #1. Per licensee, napping supplies are cleaned regularly. Bathroom #1 was maintained clean with adequate supplies for the children. All bathroom fixtures were in operating condition. Facility was the proper temperature with ventilation and natural lighting. Outlets and trash bins had been covered. Off-limit areas have been made inaccessible with child safety gates and knobs. LPA observed detergents, cleaning compounds and other items which could pose a danger, stored on high shelf and off-limit areas. Home had a functioning telephone, smoke / carbon monoxide detector and fully charged fire extinguisher (4A:60BC), located in the kitchen.

(REFER TO 809-CFOR CONT.)

SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2021
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 6
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: PAZ, NAYARA O.P. AND RONCATO, BRUNO R.
FACILITY NUMBER: 214005509
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/10/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102416.5(b)(1)
Staffing Ratio and Capacity
(b) For a Small Family Child Care Home, the maximum number of children for whom care may be provided at any one time, including children under age 10 who reside at the licensee's home, shall be one of the following: (1) Four infants; or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations, interviews and record review, LPA confirmed licensee is over capacity with five infant age children in care. This poses an immediate health and safety risk to children in care.
POC Due Date: 11/12/2021
Plan of Correction
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Licensee will reduce enrollment to the required capacity limits by the due date. Proof of correction will be submitted to the Department via email.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 11/10/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/10/2021
LIC809 (FAS) - (06/04)
Page: 2 of 6
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: PAZ, NAYARA O.P. AND RONCATO, BRUNO R.
FACILITY NUMBER: 214005509
VISIT DATE: 11/10/2021
NARRATIVE
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(Page 2)
At 10:40A.M., LPA inspected the Outdoor Play Area and Patio. Area was completely enclosed with tall fencing. LPA observed a shaded rest area available to the children. Per licensee, drinking water is made readily available to children at all times. Outdoor toys inspected were safe and in good repair. Children’s play structure was securely anchored. Licensee's does not have a swimming pool, spa, hot tub, fishpond or any other bodies of water. Storage shed was observed to be properly locked.

At 11:00A.M., LPA conducted facility records. Staff records included: Updated Mandated Reporter Training, (LIC9024) Notice of Employee Rights and (LIC508) Criminal Record Statement.

At 11:03A.M., LPA observed staff file missing proof of required immunization. Advisory Note, Technical Violation (LIC 9102TA) was issued during inspection.

Children's records included: Proof of Immunization, (LIC700) Identification of Emergency Information, (LIC627) Consent for Medical Treatment and (LIC995A) Notice of Parent's Rights.

At 11:30A.M., Based on Record Review, LPA confirmed facility is over capacity with five infant age children in care.



At 11:35A.M. LPA observed individual infant sleeping plan (LIC9227) missing from two infant files. Advisor Note, Technical Assistance (LIC9102TA) was issued during inspection.

Facility is conducting and logging required emergency disaster drills every six months. Last disaster drill was completed on 6/11/2021. Children's Roster (LIC 9040) was properly updated. Licensees and helpers, CPR/ 1st aid certification was current and expires, 9/2023. LPA observed required forms visibly posted in the playroom. Posted forms including the Facility License, Emergency Disaster Plan, COVID-19 Guidance and the Parent's Rights. Licensee stated they provides all daily snacks and meals. Children’s medication was reviewed during inspection. LPA reminded licensee to label all children food containers. Per licensee, there are no guns or weapons in the home. (REFER TO 809-C, FOR CONT.)

SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2021
LIC809 (FAS) - (06/04)
Page: 5 of 6
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: PAZ, NAYARA O.P. AND RONCATO, BRUNO R.
FACILITY NUMBER: 214005509
VISIT DATE: 11/10/2021
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(Page 3)
Licensee was reminded that all adults 18 years and over living or working in the home, including employee and volunteers, must obtain criminal clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/ day up to $500.00 maximum per day/ per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee and discussed Child Care Licensing Safe Sleep Webpage at: https://www.cdss.ca.gov/inforesource/child-care-licesning/public-information-and-resources/safe-sleep as an additional resource. LPA informed licensee of the importance of checking for recalled infant devices on United States consumer Product Safety Commission (CPSC) website at http://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. (REFER TO 809-C, FOR CONT.)

Incidental Medical Services (IMS) 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 Americans with Disabilities Act (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: www.ada.gov/childqanda.htm.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tool, please send them to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesource/community-care-licensing/inspection-process.

Based on today's inspection, deficiencies were observed in areas evaluated according to California Title 22, Health and Safety code of Regulations, and cited on the attached 9099- D. Exit interview was conducted and plan of correction was reviewed by Licensee, Nayara Paz and Bruno Rocanto. Her signature of this form acknowledges receipt of these documents. Notice of Site Visit was given and must be posted for 30 days.



Type “A” violation was issued today. Licensee was advised to provide a copy of the Evaluation Report and all Type “A” Deficiencies cited, to 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 (Deficiency and Acknowledgment of Receipt of Licensing Reports) shall be maintained in all children's files.

>This report and rights to comment and appeal were discussed with licensee. This report must be available in the facility for public review. Licensee was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov
SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2021
LIC809 (FAS) - (06/04)
Page: 6 of 6