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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004118
Report Date: 05/07/2019
Date Signed: 05/07/2019 10:02:30 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:MORALES NOVA, GLORIAFACILITY NUMBER:
384004118
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
05/07/2019
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Gloria Morales NovaTIME COMPLETED:
10:15 AM
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Licensing Program Analyst, LPA Yee conducted a scheduled pre-licensing inspection today. I met with the applicant, Gloria Morales. This is a change of location previously licensed at 809 Gonzalez Drive SF, CA 94132 facility 384002714. LPA and Gloria toured the home. It is 4 bedrooms, 2.5 bathrooms, living room, kitchen, dining room, 2 car garage, and backyard. Current residents are Gloria, her husband, their 2 children ages 8 months, 4 yr old. Daycare area: living room, dining room, kitchen, bedroom #2, and bathroom next to the kitchen. The remaining areas are off limit. The home is equipped with a smoke detector, carbon monoxide detector, and fire extinguisher. The lease agreement is on file. The applicant is advised, infant walkers, exersaucers, jumpers, bouncers and any similar items are not allowed in the daycare. The applicant has advised all adults, 18 yrs and older living in the home, the helper must have fingerprint clearance prior to having any contact with children in care. Outdoor is not licensed today. If used, need to be inspected by the licensing department. 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. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Sections 102417. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/(800) 514-0383 (TTY) and link to the publication: Commonly Asked Questions about Child Care Centers and the ADA, Available at http://www.ada.gov/childqanda.htm.
A written IMS plan was obtained today. CPR and 1st aid certificate is current until 3/19/2021. 8-hour Health and Safety certificate was completed April/2016. SIDS " A Child Care Provider's Guide to Safe Sleep" information was provided to Gloria.

Prior to licensure, Applicant must complete AB1207.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2019
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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