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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002608
Report Date: 06/21/2019
Date Signed: 06/21/2019 04:01:20 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:CARINO, ELLEN-GRACE & CEPHASFACILITY NUMBER:
384002608
ADMINISTRATOR:CARINO, ELLEN-GRACE&CEPHASFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 267-0853
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94112
CAPACITY:14CENSUS: 11DATE:
06/21/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Anamae Timtiman, Teresita Alpay, Cheryl IsulatTIME COMPLETED:
04:30 PM
NARRATIVE
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3, Licensing Program Analysts, LPAs Yee, and Ly conducted an annual random inspection today. Licensee and co-licensee are not present during the inspection. The purpose of the inspection was explained. There are 11 children (4 infants), and 3 staff members present today. Staff said licensee and co-licensee are usually here, but, today they have an appointment. Staff said residents at the facility are Ellen-Grace, Cephas, mom, dad, sister in law and their two children ages four yr old and 7 yr old. Day-care areas (lower level): playroom, bathroom, and backyard. Staff said the remaining areas of the house are off limit. The home is equipped with the fire extinguisher, carbon monoxide detector, and smoke detector. The home is ventilated properly. Required immunization for licensee and co-licensee are on file. One staff has current CPR & 1st aid certificate which expires 7/2020. LPA discussed the Mandated Reporter Training, AB1207 that was effective on 1/1/2018. All staff must take the training and keep the certificate on file. The training needs to be renewed once every 2 years. Child Abuse Mandated Reporter Training, AB1207. https://www.mandatedreporterca.com/
Children toys and equipment appear to be safe and good condition. Children files were reviewed. Some of the children files were incomplete. LPA advised staff to keep the children files current. The roster is not available. The facility provides snacks and lunches. SIDS " A Child Care Provider's Guide to Safe Sleep" information was provided and explained.

website: www.ccld.ca.gov Title 22, Div 12, Chp 3
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2019
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 3
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: CARINO, ELLEN-GRACE & CEPHAS
FACILITY NUMBER: 384002608
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/21/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/12/2019
Section Cited
HSC
1596.7995(a)(1)
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H&S 1596.7995(a)(1): Staff Immunization:
Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles.
Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
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Licensee and staff shall provide proof of immunization for all staff by the due date 7/12/2019
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Staff members do not have proof of staff immunization's (measles), TDAP, TB, Flu for review during inspection.

This poses a potential health risk to children in care.
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Type B
07/12/2019
Section Cited
CCR
102417(g)(8)
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102417 (g)(8) : Operation of a Family Child Care Home - Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841. It states each child day care facility shall maintain a current roster of children who are provided care in the facility. See Below
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LPA provided a copy of roster to the licensee. Licensee agreed to have the roster filled before July 12, 2019.
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This requirement is not met as evidenced by during record review, licensee does not has the roster available.

This poses 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: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: CARINO, ELLEN-GRACE & CEPHAS
FACILITY NUMBER: 384002608
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/21/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/12/2019
Section Cited
HSC
1596.8662(b)(5)
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H&S Code 1596.8662(b)(5) On and after January 1, 2018, a person who becomes an administrator or employee of a licensed child day care facility shall complete the mandated reporter training. All staff members need to take Mandated Reporter Training.
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The facility needs to correct this deficiency by due due.
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 Licensee, co-licensee, staff does not have the required mandated child abuse training as mandated by AB 1207.

This requirement was not met as evidence-based upon records review.
This poses a potential health 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: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2019
LIC809 (FAS) - (06/04)
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