384001543-11-3-2022-05-CC-JYEE-CKTTPY-20221103145507

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384001543
Report Date: 11/03/2022
Date Signed: 11/03/2022 02:56:14 PM

Document Has Been Signed on 11/03/2022 02:56 PM - It Cannot Be Edited

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 FRANCISCO	STATE: CA	ZIP CODE:	94112
CAPACITY:	14	CENSUS: 5	DATE:	11/03/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Monique N. Guidry		TIME COMPLETED:	03:15 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) Yee conducted an unannounced, Required - 1 year inspection today. The purpose of the inspection was explained. Present at the facility are licensee, Monique, helper and 5 napping children. LPA inspected the daycare areas with Monique. Current residents are Monique, and her son. The facility personnel summary report was reviewed with Monique. Hours of operation are Monday to Friday from 8:00 am to 5:00 pm. *DAY CARE AREAS:* *(ground level): kitchen/dining room, bathroom, family room, den and back yard.* The remaining areas are off limit. LPA observed the home to be in good repair with proper temperature and ventilation. There were a variety of age-appropriate toys and equipment in the home which were in good condition. There were no swimming pools, spas, or bodies of water on the property. All cleaning supplies, poisons, and other chemicals were stored inaccessible to children behind child-safety locked cabinets. There was a working smoke detector and carbon monoxide detector, a fully charged fire extinguisher that meets the fire department standard, and a working telephone on site. Per Licensee, there are no weapons or guns in the home. LPA reviewed all 5 children's records and is in order. Continue next page.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer Yee	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022

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: GUIDRY, MONIQUE N.	FACILITY NUMBER: 384001543
	VISIT DATE: 11/03/2022

NARRATIVE

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LPA reviewed Licensee's Pediatric First Aid/CPR which is current and will expire 11-2023. Earthquake drill is practice daily as part of the circle time. Last fire drill was conducted on 10-6-2022.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

This facility provides Incidental Medical Services - IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children's, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 102417. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/(800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, Available at: http://www.ada.gov/childqanda.htm.

LPA review AB 1207 with the Licensee. As of January 1, 2018, all staff members are required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer Yee	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022

LIC809 (FAS) - (06/04)

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