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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384003092
Report Date: 11/06/2019
Date Signed: 11/06/2019 10:38:25 AM

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:CHAPMAN, NICOLEFACILITY NUMBER:
384003092
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 5DATE:
11/06/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Nicole Chapman and Dana ChapmanTIME COMPLETED:
11:05 AM
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Licensing Program Analyst (LPA) Mok conducted an unannounced case management inspection today. The purpose of the inspection was explained to them. There were 5 children included 2 infants present. Licensee submitted an application to CCL for Capacity increased on 10/21/2019. The fire clearance approval was received by CCL on 11/1/2019. The day care areas will be: living room, kitchen, bathroom, Bedroom #1, and the backyard. The off-limit areas will be: Bedroom #2, sun room, and the entire lower lever except backyard. LPA inspected the facility for health and safety hazard. The house was clean and in order. Temperature and lighting were adequate. All toxins and harmful object were either locked or made inaccessible. Per SF Fire Marshal request, licensee built a stairway to the backyard from the Sunroom on the upper level, so the Sun room will be used as a pathway for the children to the backyard only. The daycare children cannot stay in the sun room for any activities. The facility has plenty of age appropriate toys, books, learning equipment and children furniture available for the children. Windows were installed the window locks in the living room and kitchen to limit the windows to be opened up to 4 inches. Gate was installed at the stairway to prevent children access to the off limit area. There were a fully charged 2A10BC fire extinguisher, working carbon monoxide and smoke detectors in the house.

The following items have to be completed before CCL approves for Large Family Child Care Home license:
  • Gates have to be installed at the stairway in the backyard.
  • Licensee has to barricade the play area for the children in the backyard.



This report and notice of site visit were discussed with the licensee and must be made available to the public upon request. For quarterly update on Licensing information, go to CCL website: www.ccld.ca.gov. For Provider Information Notice: ccld.ca.gov/PG5098.htm
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy MokTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2019
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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