<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214200002
Report Date: 07/09/2019
Date Signed: 07/09/2019 03:35:05 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:ALFONSO, AURA MARINAFACILITY NUMBER:
214200002
ADMINISTRATOR:ALFONSO, AURA MARINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 479-1913
CITY:SAN RAFAELSTATE: CAZIP CODE:
94903
CAPACITY:14CENSUS: 10DATE:
07/09/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Licensee, Aura Marina AlfonsoTIME COMPLETED:
03:50 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 Licensee, Aura Marina Alfonso. Purpose of the inspection was explained and was for an Annual/Random inspection. Present in the facility is Licensee and 2 helpers (mother) caring for 10 children. (3 Infants 7 PreK). All adults living and helping in the home have Criminal Record Clearance on file. Licensee is within capacity limits of the License. Licensee’s home is a 3 bedroom, 2 bathroom, 1-level house. Hours of Operation are: Mon- Fri: 7:30am-5:30pm. Daycare areas are: Playroom, Bathroom #1 and Backyard Off Limit areas are: Kitchen, Living Room, Bedroom# 1, Bedroom #2, Bedroom #3 and Bathroom #2. All off limit areas are properly barricaded with child safe fencing. There are no bodies of water or fireplace's in the Daycare area. LPA Gomez observed the following: Daycare area is clean, orderly, and equipped with age appropriate toys and equipment for the children. Home has ample lighting and ventilation. Home has a home telephone, a working smoke and carbon monoxide detector, and a fully charged fire extinguisher. There are no poisons, detergents, cleaning products, or sharp objects accessible to daycare children. Licensee stated there are no guns or weapons in the home. Licensee’s cardiopulmonary resuscitation certifications expires: 1/2020. Licensee conducted last emergency drill on 5/2019 and is properly logged. Licensee stated she provides meals for children in care. All required postings are properly posted in the daycare. Licensee stated home has a pet cat and dog. Licensee stated all pets are vaccinated in file.

LPA reviewed children’s files and facility roster during today’s visit. LPA observed children’s files and facility roster are complete and up to date.

See Page 2. . .
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8832
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 393-9134
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2019
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: ALFONSO, AURA MARINA
FACILITY NUMBER: 214200002
VISIT DATE: 07/09/2019
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
Page 2. . .
During inspection,
*Technical Assistance (LIC 9102) was issued to licensee.
*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.


>No deficiencies were issued today under Title 22 Division 12 of the Ca. Code of Regulations.

>This report and rights to comment and appeal were discussed with Licensee. 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 MaligTELEPHONE: (650) 266-8832
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 393-9134
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2