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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001615
Report Date: 12/16/2019
Date Signed: 12/16/2019 09:43:28 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:AMAYA, JOVANNYA L.FACILITY NUMBER:
384001615
ADMINISTRATOR:AMAYA, JOVANNYA L.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 334-9524
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94112
CAPACITY:14CENSUS: 8DATE:
12/16/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Jovannya L. AmayaTIME COMPLETED:
10:00 AM
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3, Licensing Program Analyst, LPA Yee conducted an annual random inspection today. There are 8 children, licensee, Jovannya, her mother/helper, Luz present today. The purpose of the inspection was explained. The facility personnel summary report was reviewed with the licensee, she said it's correct. Current residents at the facility are Jovannya, her mother, her 8 yr old daughter, and her niece. Daycare areas are the same as last year. Day-care areas: Living room, dining room, bathroom, and back yard. The back yard is not used due to the weather. The back yard needs a general clean up. Jovannya said she will clean it up before she reuses the yard again. The remaining areas of the house are off-limits. The home is equipped with a smoke detector, carbon monoxide, and a fully charged fire extinguisher. The facility has one small dog and a cat and kept in the off-limit areas. The immunization for both dog and cat was reviewed during the inspection. Both staff members have current CPR & 1st aid certificate is current until 07/27/21. 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. www.mandatedreporterca.com. Jovannya said she is still waiting for the one in Spanish. A written IMS is on file. Children's files were reviewed today. SIDS " A Child Care Provider's Guide to Safe Sleep" is provided. The classroom temperature is 52 degrees Fahrenheit. LPA pointed it out and licensee turn on the heater to warm up the room. The last emergency drills were conducted on 12/4/2019. A log sheet was reviewed.

Website: www.ccld.ca.gov. Title 22, Div12, Chp3

Office: Monday - Friday, 8:00 a.m. - 5:00 p.m. (650) 266-8800
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2019
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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