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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001615
Report Date: 08/04/2022
Date Signed: 08/04/2022 03:29:48 PM


Document Has Been Signed on 08/04/2022 03:29 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: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:
08/04/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Jovannya L AmayaTIME COMPLETED:
03:45 PM
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Licensing Program Analyst, LPA Yee conducted a required - 1 year inspection today. The purpose of the inspection was explained. The facility personnel summary report was reviewed with Amaya and updated during the inspection. Present at the facility are the licensee, Amaya, her mom, her sister, and 8 children. Current residents are the licensee, Amaya, her boyfriend, her mom, her sister and her 10 years old daughter. All adults living and/or working in the home have a criminal record clearance on file. Hours of operation are Monday to Friday from 8:00am to 5:00pm

Day-care areas: Living room, dining room, front room, bathroom, and back yard. The remaining of the house are off limits. LPA toured day care areas of home with Amaya. The home is ventilated properly. The children toys are age appropriate and in good condition. There are no pools, spas or bodies of water on the property. The backyard is enclosed with an least 5ft high fence. Backyard is equipped with appropriate outdoor toys and equipment that are in good working condition. The facility provides snacks and lunches. The facility participate in a food program.

The home is equipped with a working smoke detector and carbon monoxide detector, a fully charged fire extinguisher. Per Licensee, there are no guns or weapons in the home.

LPA reviewed 8 children files. Children files are in order.

LPA reviewed Licensee's Pediatric First Aid/CPR which is current and will expire 11/2023. Last emergency drill/fire drill was conducted on July 11, 2022. A log sheet was available for a review.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 08/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/04/2022
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: AMAYA, JOVANNYA L.
FACILITY NUMBER: 384001615
VISIT DATE: 08/04/2022
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During the inspection LPA discussed the following:

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://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 log sheet was available for review.

LPA discussed Child Abuse Mandated Reporter Training AB1207 with Licensee. As of January 1, 2018 all staff will be required to complete Child Abuse Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. The licensee can not find her certificate. However, she stated that she and her sister took it on June-02-2022. The sister certificate is on file.

An exit interview was conducted with Licensee. Notice of Site Visit is to remain posted for 30 days. For updates on Licensing information, go to CCL website: www.ccld.ca.gov. For Provider Information Notice: ccld.ca.gov/PG5098.htm
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2022
LIC809 (FAS) - (06/04)
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