214200015-5-7-2019-05-CC-LGOZ-BBXNSC-20190507104254

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 214200015
Report Date: 05/07/2019
Date Signed: 05/07/2019 10:43:34 AM

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:	BATES, LINDA		FACILITY NUMBER:	214200015
ADMINISTRATOR:	BATES, LINDA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 381-8399
CITY:	MILL VALLEY	STATE: CA	ZIP CODE:	94941
CAPACITY:	14	CENSUS:	DATE:	05/07/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Linda Bates		TIME COMPLETED:	10:55 AM

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, Linda Bates. Purpose of the inspection was explained and was for an Annual/Random inspection. Present in the facility is Licensee and helper (Daughter) caring for 7 children. All children present in the facility are in PreK. Licensee is within capacity limits of the License. Licensee rents home, which is a 3 bedroom, 2 bathroom, 1 -level house. Hours of Operation are: 9:00-1:00pm Mon-Thur. Daycare areas are: Yard Area, Backyard Bungalow (Playroom) and Bathroom #1 (located inside the home). Off Limit areas are: Entire home (Bedroom #1, Bedroom #2, Bedroom #3, Kitchen, Living Room (Pass Through Only) and Bathroom #2). All off limit areas are properly barricaded. LPA observed the following: Daycare area is clean, orderly, and equipped with age appropriate wooden toys and blocks for the children in care. Daycare has ample lighting and ventilation. Daycare has a working cell phone, smoke and carbon monoxide detector, and a fully charged fire extinguisher. LPA reminded licensee that her cell phone must remain in the daycare at all times. Licensee states she has 2 pet dogs. All vaccinations are current. There are no bodies of water in the Home. There are no poisons, detergents or cleaning products accessible to daycare children. Licensee states there are no guns or weapons in the home. Licensee CPR certification expire: 10/25/2019. Licensee conducted last emergency drill on 1/7/2019 and is properly logged. Licensee states she provides daily snacks, and children also bring their own meals. All meals are properly labeled. Discipline policy is talk out problems with others and positive reinforcement. All required postings are properly posted next to the main door. Licensee and helper have required proof of immunization and Mandated Reporter Training certificate on file. Children’s roster was reviewed and is complete and up to date. Continue to page 2...

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8832
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 393-9134
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2019

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: BATES, LINDA	FACILITY NUMBER: 214200015
	VISIT DATE: 05/07/2019

NARRATIVE

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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.

>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 Malig	TELEPHONE: (650) 266-8832
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 393-9134
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2019

LIC809 (FAS) - (06/04)

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