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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005520
Report Date: 08/24/2020
Date Signed: 08/24/2020 02:52:49 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:ARANTES DA SILVEIRA, SOLANGEFACILITY NUMBER:
214005520
ADMINISTRATOR:ARANTES DA SILVEIRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 407-6865
CITY:MILL VALLEYSTATE: CAZIP CODE:
94941
CAPACITY:14CENSUS: 0DATE:
08/24/2020
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Applicant, Solange Arantes Da SilveiraTIME COMPLETED:
03:00 PM
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On August 24, 2020 at 2pm Licensing Program Analyst (LPA) Kassandra Medrano met with applicant, Solange Arantes Da Silveira for a pre-licensing inspection via FaceTime due to COVID-19 shelter-in-place. Applicant single story home, she lives with another adult. Home has 6 bedrooms and 2 bathrooms. Hours of operation will be Monday to Friday 8AM to 5PM. Child care will be provided in areas: Bedroom #2, Bedroom #3. Living Room, Kitchen, Dinning room will remain on limits to reach back bedrooms and bathroom. As well as backyard. Off limit areas: Bedroom #1,Bedroom #4, Bedroom #5, Bedroom #6. All off limits areas are made inaccessible to children. LPA inspected the entire home with the applicant for health and safety hazards. The house has proper temperature and ventilation. All toxic or dangerous materials are stored in cabinets with child protective locks installed making them inaccessible. There is a fire place located in the home, and it is properly barricaded. The house has a working telephone, fully charged fire extinguisher, smoke detector, and carbon monoxide detector. The fire department has made their inspection and granted fire clearance as of August 4th, 2020. Applicant has first aid supplies available. There are a variety of age appropriate toys available. As per the applicant, there are no firearms or weapons in the home. Per applicant, there are no pets in the home. Applicant was informed that time outs cannot be any longer than one minute per age of the child and cannot exceed five minutes. Applicant states that her form of discipline will be redirection. LPA informed the applicant that emergency drills will be conducted at least once every six months and drills must be logged. Applicant's First Aid/CPR certificate expires in 01/2021. Applicant has been made aware that they need required postings in the home. LPA discussed facility ratios and capacity's with the applicant. The applicant was reminded there are no walkers, exersaucers, jumpers, bouncers and any similar items to be used for children in care and shall be made inaccessible. Licensee is advised 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 CDL or Ca. ID prior to having any contact with the children in care and failure to do so could result in an immediate civil penalty of $100.00 each day.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Kassandra MedranoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2020
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: ARANTES DA SILVEIRA, SOLANGE
FACILITY NUMBER: 214005520
VISIT DATE: 08/24/2020
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During inspection,
-Incidental Medical Services (IMS) policy was discussed.
-Licensee was reminded about having all Staff and Volunteers provide proof of immunization against influenza, pertussis, and measles or qualifies for an exemption.
-Licensee was reminded about the Provider Information Notices (PINs) on CCLD website.
-Licensee was reminded about Mandated Reporter Training available on CCLD website
(www.ccld.ca.gov or www.mandatedreporterca.com).
-Licensee was given information regarding ‘Safe Sleep’ practices.

Capacity limits of a Large License have been reviewed with Licensee.

License will be recommended for approval when the following is updated and proof is received in office:
- Fingerprint Clearance

This report will be kept in the facility file and will be made available for public review upon request. Desk duty is available Monday - Friday, 8:00a.m.- 5:00p.m. (650) 266-8800.
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: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Kassandra MedranoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2020
LIC809 (FAS) - (06/04)
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