214200078-6-11-2019-05-CC-FBTQ-BD2VQN-20190611163838

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 214200078
Report Date: 06/11/2019
Date Signed: 06/11/2019 04:38:46 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:	CARLOS & ROSA AMALIA GARCIA		FACILITY NUMBER:	214200078
ADMINISTRATOR:	GARCIA, ROSA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 892-2493
CITY:	NOVATO	STATE: CA	ZIP CODE:	94947
CAPACITY:	14	CENSUS: 6	DATE:	06/11/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	03:20 PM
MET WITH:	Carlos & Rosa Amalia Garcia		TIME COMPLETED:	04:50 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) Farhan Bashir-Tariq met with the Licensees Carlos & Rosa Amalia Garcia to conduct an Annual Random inspection on 6/11/19. The purpose of the inspection was explained . Present there were six children in care with the Licensees. All adults living or working in the home have fingerprints clearance on file. Licensee is operating within the capacity and ratio limit as of today 6/11/19. The operation hours are M-F, 7:30 AM-5:30 PM. Licensee provides Breakfast, Lunch and 2 snacks. Name of the day care is Tia Amalia's Day Care. LPA and Licensee Rosa inspected the entire day care area for Health and Safety Hazards. Day Care areas: Play room , Living room, Dining area, Bathroom, Backyard, Bedroom #1 and Bedroom #2. Off limit areas: Kitchen, Master Bedroom and attached Bathroom. All off limit areas are properly barricaded and made inaccessible to the children in care. Per licensee there are no bodies of water, firearms/weapons, or poisons on the premises. Licensee states, there are is a cat in the home. The home is equipped with a smoke alarm, a carbon monoxide detector, and a fully charged fire extinguisher that meets minimum size requirements. There is a fire place in the home, which has been barricaded with a built-in screen. The home is clean and free of hazards with a sufficient amount of learning materials and furniture in well repair available to the children. Cabinets in the bathroom has child protective locks. There is a gate installed to barricade the access to the kitchen by the children in care. Continuation on next page...

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8867
LICENSING EVALUATOR NAME: Farhan Bashir-Tariq	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/11/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2019

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: CARLOS & ROSA AMALIA GARCIA	FACILITY NUMBER: 214200078
	VISIT DATE: 06/11/2019

NARRATIVE

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Both the Licensees has the CPR and First Aid training valid until October 2020. LPA reminds the Licensee to conduct the fire or emergency drills at least once every six months and drills must be logged. Licensee has a log for each drill being conducted. Per licensee’s log, last drill was conducted on May 22, 2019. Licensee presented a current roster of children and all posting requirements are met. LPA obtained a copy of the roster. Children's files and adult files were reviewed. Children's files are current and complete. Adult files are complete with immunization records and first aid and CPR certification.
LPA reminds Licensee, all adults, 18 years and older living in the home, helper, or assistant must have finger print clearance and must be associated to the facility by submitting an LIC 9182 with a copy of CDL or CA. ID prior to having any contact with children in care failure to do so could result in an immediate civil penalty.
LPA reminds Licensee that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662. LPA observed the record of immunization of Licensees.
LPA encourage the facility to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. Facility can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.
Safe Sleep Regulation, Safe Sleep Environment, Items not permitted in a home and SIDS handouts were provided to the Licensee.

>No deficiencies were cited today under Title 22 Division 12 of the California 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 shall be posted for 30 days from today's visit.
Licensee was advised for any additional questions to call Office, M-F, 8AM-5PM at 650-266-8800 . For Rules and Regulations, visit the Website: www.cdss.ca.gov

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8867
LICENSING EVALUATOR NAME: Farhan Bashir-Tariq	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/11/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2019

LIC809 (FAS) - (06/04)

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