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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001543
Report Date: 11/19/2019
Date Signed: 11/19/2019 01:58:08 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:GUIDRY, MONIQUE N.FACILITY NUMBER:
384001543
ADMINISTRATOR:GUIDRY, MONIQUE N.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 990-7470
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94112
CAPACITY:14CENSUS: 8DATE:
11/19/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Monique N. GuidryTIME COMPLETED:
02:15 PM
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2, Licensing Program Analyst, LPA Yee conducted an annual random inspection today. There are 8 children, licensee, Monique Guidry, 1 helper and two students in training present today. The purpose of the inspection was explained. Daycare is located in the lower level. The entire upper level is off-limit. No change in the daycare areas. Day-care areas (ground level): kitchen/dining room, bathroom, family room, den and back yard. CPR & 1st aid certificate is current until 10/2021. Staff immunization is on file. Child Abuse Mandated Training, AB1207 certificate is on file. LPA reminded that the training needs to be renewed once every 2 years. A written IMS plan is on file. Current residents are Licensee and her son only. The facility provides snacks and children to bring their own lunches. Children's files were reviewed. The discipline policy is communication. The facility has childcare insurance. SIDS "A Child Care Provider's Guide to Safe Sleep" information was provided. The facility is in compliance.

www.ccld.ca.gov. title 22, Div 12, Chp 3
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2019
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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