<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002365
Report Date: 03/05/2020
Date Signed: 03/05/2020 02:59:31 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:FLORES, ANDREA & TORRES, ARTUROFACILITY NUMBER:
384002365
ADMINISTRATOR:FLORES, ANDREA & TORRES, AFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 742-4526
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94112
CAPACITY:14CENSUS: 12DATE:
03/05/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Andrea FloresTIME COMPLETED:
03:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst, LPA Yee conducted a required 1-year inspection today. The purpose of the inspection was explained. There are 12 children (3 infants), licensee, Andrea Flores, and helper present today. Current residents are Andrea, her husband and her father in law. All adults living or working in the home have a criminal background check on file. Days and hours of operation: Monday to Friday between 8:00 AM to 5:00 PM.

LPA inspected the daycare areas with Andrea. Day Care Areas: living room, dining room, bathroom, bedroom #1 and back yard. The remaining areas of the house are off-limits. Off limit areas are made inaccessible. The home is free of hazards with proper temperature and ventilation. Per Andrea, a carbon monoxide detector, smoke detector are working. A fire extinguisher is fully charged.

At 2:00 PM, LPA reviews the children's records and staff records. LPA reviewed the identification and emergency information form for every child for proper names and numbers filled. The licensee has a record of children’s immunization. The licensee has a record of training of preventive health and CPR card valid until March 2021. Licensee conducted the fire drill on 2/25/2020, and a log sheet was reviewed. Required immunization for staff is on file.

Incidental Medical Services (IMS) policy was discussed. A written IMS is on file.
LPA review 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. The licensee competed for her AB 1207 certificate is on file.

LPA discussed the safe sleep regulation concepts and the handout was provided.
This report was reviewed and provided to the licensee. Notice of site visit is posted and shall remain posted for the next 30 days.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
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: FLORES, ANDREA & TORRES, ARTURO
FACILITY NUMBER: 384002365
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/05/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/19/2020
Section Cited

1
2
3
4
5
6
7
Child's Records: The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d).

The facility do not have C10, C11, C12 records available.
8
9
10
11
12
13
14
This requirement was not met as evidence-based upon records review, the licensee failed to maintain current records.

This poses a potential health risk to children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7

1
2
3
4
5
6
7
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: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 03/05/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/05/2020
LIC809 (FAS) - (06/04)
Page: 2 of 2