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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005509
Report Date: 12/08/2021
Date Signed: 12/08/2021 10:53:37 AM

Document Has Been Signed on 12/08/2021 10:53 AM - It Cannot Be Edited

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: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
12/08/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Nayara Paz, Bruno RoncatoTIME COMPLETED:
11:00 AM
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On 12/8/2021 at 9:35P.M., Licensing Program Analyst (LPA), Luis J. Gomez met with Licensee, Nayara Paz and Bruno Roncato. The purpose of today’s inspection was explained, which was an unannounced, Case Management inspection for increase in capacity. Licensee also requested to add Master Bedroom (Bedroom #3) to the on-limit, day-care areas. Present was both licensees and one helper caring for six children. (3 Preschool Age and 3 Infant Age) Facility was operating below capacity limits stated on license. 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, Bedroom #3 (Napping only), Bathroom #1, Backyard and Patio. Off-limit Area: Living room, Kitchen, Dining Room, Bedroom #2, Bathroom #2 and Garage. LPA inspected home, inside and outside, with licensee for health and safety hazards.

At 9:40A.M., LPA observed the following: Day-care areas were clean and orderly. Playroom was equipped with age appropriate toys and games for the children. Cubbies and child sized tables and chairs were available. Off-limit area have been properly barricaded with child safety gates and knobs. For nap time, several infant playpens are located in bedroom #1. Bathroom #1 was clean with adequate supplies for the children. Home does not have a swimming pool, spa, hot tub, fishpond or any other bodies of water. Day-care has a functioning home phone, smoke /carbon monoxide detector combo, and a fully charged fire extinguisher (2A:10BC), located in the kitchen. Licensee's CPR/ First Aid certification was current, expiring: 9/2023.

At 9:45A.M., LPA inspected bedroom #3. Per licensee, Bedroom #3 will be used for napping only. Bedroom was free of hazards or dangerous conditions. Bedroom #3 has been added to on-limit areas. (REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 12/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/08/2021
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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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: 12/08/2021
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During inspection, large license capacity limits were reviewed with both licensees. Licensees were reminded that when operating at a large capacity, there must be at least one helper present.

Licensees submitted updated Facility Sketch (LIC999) during inspection.

Prior to recommendation for Increase in Capacity, licensee must submit the following documents:

-Submit approved fire clearance request (STD850)

This report must be available in the facility for public review. Notice of site visit was observed being posted. Licensee was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.cdss.ca.gov

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2021
LIC809 (FAS) - (06/04)
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