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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001678
Report Date: 12/17/2019
Date Signed: 12/17/2019 03:49:40 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:HERRERA, MARIA TERESA & DARSY YANINAFACILITY NUMBER:
384001678
ADMINISTRATOR:HERRERA, MARIA T. & DARSYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 585-2185
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94112
CAPACITY:14CENSUS: 9DATE:
12/17/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Darsy HerreraTIME COMPLETED:
04:30 PM
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3, Licensing Program Analyst, LPA Yee conducted an annual random inspection today. The purpose of the inspection was explained. There are 9 children, licensee and 2 helpers present today. Current residents at the facility are Darsy and her husband. Maria and her husband are on vacation. The facility personnel summary was reviewed with Darsy and she said it's current. Day-care areas (lower level): garage converted into day-care, classroom #1, dining room, side bedroom used as an infant nap room and backyard. The backroom is used as storage and off-limit. The entire upper level is off-limit. The facility provides snacks and lunches. All staff members have current CPR & 1st aid which expires 11/2021. Required immunization for staff is on file. The home is equipped with a smoke detector, carbon monoxide detector and fire extinguisher are fully charged. 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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, Available at http://www.ada.gov/childqanda.htm. A written IMS is on file. SIDS "A Child Care Provider's Guide to Safe Sleep". information was provided. Licensee, Darsy and one of her staff members has "Child Abuse Mandated Reporter Training, AB1207" www.mandatedreporterca.com certificate on file. However, co-licensee, Maria will take the class when she is back in town. And licensee other staff is waiting for the Spanish version. Last emergency drill was practiced on 11/5/2019. Children's files were reviewed and in order.

website: www.ccld.ca.gov. Title 22, Div 12, Chp3
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2019
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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