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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384000794
Report Date: 09/25/2019
Date Signed: 09/25/2019 02:41:08 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:MANCASOLA, AMYFACILITY NUMBER:
384000794
ADMINISTRATOR:MANCASOLA, AMYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 664-4745
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94127
CAPACITY:14CENSUS: 0DATE:
09/25/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Amy MancasolaTIME COMPLETED:
03:00 PM
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3, Licensing Program Analyst, LPA Yee conducted an annual random inspection today. There are 12 napping children, two helpers and licensee present today. The purpose of the inspection was explained. Current residents are Amy Mancasola, her husband and their children ages 15 and 17 yrs old. LPA reminded Amy that when her child turns 18 years of age, he will need a fingerprint clearance. No change in the daycare areas. Day-care areas (lower level) only: playroom, art room, deck, back yard, and bathroom. The remaining areas of the house are off-limits. The garage is off-limit. The home is ventilated properly. The home is equipped with a fire extinguisher, carbon monoxide detector, and a smoke detector. The facility serves snacks and children bring their own lunches. The facility carries liability insurance. CPR/1st aid is current until 3/2020. A written Incidental Medical Services (IMS) policy is on file. Required immunization for staff members is on file. LPA discussed the Mandated Reporter Training, AB1207 that was effective on 1/1/2018. All staff must take the training and keep the certificate on file. The training needs to be renewed once every 2 years. Child Abuse Mandated Reporter Training, AB1207. https://www.mandatedreporterca.com/. Both licensee and helpers took the child abuse mandated training and certificates are on file. Children files are reviewed. SIDS "A Child Care Provider's Guide to Safe Sleep" information was explained and provided. Children files were reviewed and in order. Discipline policy is communication. The current roster is available. The emergency drill was conducted June-2019. The facility is in compliance.
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website: www.ccld.ca.gov. Title 22, Div 12, Chp 3
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2019
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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