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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001701
Report Date: 05/03/2022
Date Signed: 05/03/2022 03:44:19 PM


Document Has Been Signed on 05/03/2022 03:44 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:GARCIA-MEZA, KIM M.FACILITY NUMBER:
384001701
ADMINISTRATOR:GARCIA-MEZA, KIMFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 517-1819
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94112
CAPACITY:14CENSUS: 11DATE:
05/03/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Kim Garcia-MezaTIME COMPLETED:
12:15 PM
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Licensing Program Analyst, LPA Yee conducted a Required - 1-year inspection today. The purpose of the inspection was explained. There are 11 children, licensee and 2 helpers at the facility today. LPA and Kim tour the facility. Residents at the facility are Kim, her husband, their children ages 21, 19 and 16 yr old. The 19 years old son is away for college. Facility personnel summary report was reviewed with Kim during the inspection and it's current. Days and hours of operations are from Monday - Friday, 8:50 a.m. - 4:00 p.m., 1 p.m. Day-care areas (ground floor) only: large playroom, library room, bathroom, and backyard.
The remaining areas of the house are off-limits. The home is equipped with a smoke detector, a carbon monoxide detector, and a fully charged fire extinguisher. The licensee and helper has current CPR & 1st aid until 02-13-2023. The facility is on the food program. Child Abuse Mandated Reporter Training, AB1207 certificate is on file. Liability insurance is on file. Kim said she doesn't remember when was the last emergency drill conducted but, will do one today.
LPA discussed the safe sleep regulations with the 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. The facility has no infants. Children files were reviewed. The facility is in compliance.

Website: 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: 05/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/03/2022
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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