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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004124
Report Date: 06/20/2019
Date Signed: 06/20/2019 09:31:26 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:ARMENTA, JESSICA E.FACILITY NUMBER:
384004124
ADMINISTRATOR:ARMENTA, JESSICA E.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 347-7271
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94112
CAPACITY:14CENSUS: 5DATE:
06/20/2019
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Jessica E. ArmentaTIME COMPLETED:
09:45 AM
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Licensing Program Analyst conducted a change of location and an increase in an inspection today. There are 5 children, licensee, Jessica and her grandmother present today. Jessica was previously licensed at 40 Montana Street, SF, CA 94112. The home is owned by the licensee's mother. The home maintains three bedrooms, two restrooms, a living room, dining room, kitchen, and back yard. Daycare areas: living room, dining room, bedroom #1 (front), hallway bathroom, and backyard. The remaining areas are off limit. Current residents are licensee, Jessica, her husband, her grandmother, and their 2 sons. Required immunization for the licensee and helper are on file. The home is clean, safe, and has a working smoke detector, carbon monoxide detector, and fire extinguisher. Children toys are clean, safe and age-appropriate, the home meets the required postings (parents rights, emergency evacuation plan, and earthquake preparedness plan). Jessica states she does not own any guns or weapons. The home is heated and ventilated properly. LPA discussed fire drills and emergency evacuation drills must be conducted and logged at least once every six months. CPR & 1st is current until 3/2021. 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/. AB1207 certificate for both staff members are on file.
This facility provides Incidental Medical Services - IMS. LPA reviewed storage of medication and equipment/supplies and reviewed children's, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 102417. 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.
SIDS "A Child Care Provider's Guide to Safe Sleep" information was explained and provided to Jessica. The ratio for large was explained and capacity worksheet was provided as reference.

Prior to licensure, fire clearance approval is needed.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2019
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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