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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002347
Report Date: 01/16/2020
Date Signed: 01/16/2020 12:25:50 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:LARREYNAGA, MAGDALENAFACILITY NUMBER:
384002347
ADMINISTRATOR:LARREYNAGA, MAGDALENAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 829-2294
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94124
CAPACITY:14CENSUS: 9DATE:
01/16/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Magdalena LarreynagaTIME COMPLETED:
12:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Rodriguez met with licensee Maagdalena Larreynaga today for an unannounced annual random inspection. The purpose of the inspection was explained. Licensee and licensee's helper, Maria, was present in the facility today. Present today are nine children; two infant aged and seven preschool age children. All adults living or working in the home have criminal background check on file. LPA inspected the day care areas with the licensee. Day Care Areas: Living Room, Dining Room, Napping Room, Bathroom and Backyard. Off limit areas: Master Bedroom and Kitchen. There is no pool, spa or any other body of water on the property. Per licensee, there are no firearm or weapon in the house. All the cleaning supplies, poisons and other chemicals are stored inaccessible to the children. The house is in good repair and free of hazards with proper temperature and ventilation. There is carbon monoxide detector, smoke detector, fully charged fire extinguisher and working telephone available in the house. There is a variety of age appropriate toys in the house. LPA reviewed an updated children's roster. Licensee has a current CPR card valid until October of 2020. Licensee has record of immunizations for her and her helper. LPA reviewed AB 1207 with the Licensee. As of January 1, 2018 all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. Licensee completed Mandated Reporter Training August 2018.

LPA discussed the effects of lead exposure with the licensee and provided handout. LPA encouraged the provider to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. Licensee can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates. LPA discussed safe sleep practices and provided handouts in spanish. Licensee was informed about her licensing fees and a fee printout was provided to the licensee.

See 809D for citations given today.

The copy of this report is reviewed and provided to the licensee. Notice of site visit is posted and shall remain posted for next 30 days.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Adam RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2020
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: LARREYNAGA, MAGDALENA
FACILITY NUMBER: 384002347
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/16/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/31/2020
Section Cited

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102417(g)(9)(A)(1) Operation of a Family Child Care Home. All homes shall conduct fire and disaster drill at least once every six months and document the date and time of each drill.
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This requirement is not met as the licensee was not able to provide documentation of conducting and recording an emergency disaster drills every 6 months. This is a potential health and safety risk to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Adam RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 01/16/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/16/2020
LIC809 (FAS) - (06/04)
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