214005515-7-27-2020-05-CC-LGOZ-BRWU96-20200727152237

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 214005515
Report Date: 07/27/2020
Date Signed: 07/27/2020 03:22:43 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:	CATZIM DIAZ, REINA G.		FACILITY NUMBER:	214005515
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 6	DATE:	07/27/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	ANNOUNCED	TIME BEGAN:	10:35 AM
MET WITH:	Licensee, Reina G. Catzim Diaz		TIME COMPLETED:	11:30 AM

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THE FOLLOWING INSPECTION WAS CONDUCTED VIA TELE- INSPECTION DUE TO THE COVID-19.

On 7/27/2020 at 10:35A.M., Licensing Program Analyst (LPA), Luis J. Gomez met with licensee, Reina G. Catzim Diaz. The purpose of the inspection was explained and is for a Case Management inspection for an Increase in Capacity. Present during inspection is the licensee and her daughter, caring for six children; four preschool age, two infant age. Infant present is the licensee’s daughter. Licensee is within the required capacity limits of the license on this day. Licensee rent the home with her husband and their two children; one minor and one infant age. The home is one- story house with two- bedrooms and one bathroom. All adults have proper criminal record clearances on file. Daycare areas are: Living Room, Bedroom #2 (napping only), Bathroom #1, Kitchen (pass through only) and Backyard. Off limit areas are: Bedroom #1 (Master), Garage Area and Front Yard. LPA inspected home with licensee for health and safety hazards.

At 10:40AM., LPA observed the following: Day-care area is clean, orderly with age appropriate toys, crafts and puzzles for the children. All furniture and cubbies inspected are in good repair. Licensee has installed soft, padded floor squares for added safety. There are several child sized tables and chairs available in the living room. The off-limit areas are properly barricaded with safety gates, handles and locked doors. Licensee has napping mats stored in the living room. Bedrooms #2, located in the hallway, are free of hazards or dangerous conditions. Bathroom #1 is maintained clean with adequate supplies for the children. Accessible cabinets have child safe locks installed. Toxins, detergents and cleaning supplies are stored in an off-limit area.

Continuation on 809-C

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2020

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: CATZIM DIAZ, REINA G.	FACILITY NUMBER: 214005515
	VISIT DATE: 07/27/2020

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At 10:50A.M., LPA observed the outdoor play area in completely enclosed. Licensee has a swing set and a variety of equipment that are in good repair. Home does not have a swimming pool, spa, hot tub, fishpond or any other bodies of water. Licensee has a pet rabbit in the backyard area, inaccessible to the children. Electrical outlets and trash cans in the facility are properly covered or made inaccessible. Home has a functioning cell phone, smoke detector, carbon monoxide detector and a fully charged fire extinguisher (2A:10BC) located in the garage. There is a first aid kit located in the facility. Licensee’s CRP/ 1^st aid certification is current expiring 12/2020. Licensee stated there are no guns or weapons in the home. Licensee provides all daily snacks and meals.

Licensee was reminded that when operating at a large capacity, there must be a helper present.

Discussed during inspection include:

Facility’s Incidental Medical Services (IMS) policy, Helper’s CPR/ 1^st aid certification requirement and capacity limits of a large license.

On 7/14/2020, Fire Clearance Request was granted by the Novato FD

Prior to recommendation for large capacity, licensee must complete the following:

-Submit current lease agreement with the licensee’s name

-Submit proof of immunization's

-Submit current Mandated Reporter Training Certification

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

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2020

LIC809 (FAS) - (06/04)

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