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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004124
Report Date: 06/08/2022
Date Signed: 06/08/2022 01:16:47 PM


Document Has Been Signed on 06/08/2022 01:16 PM - It Cannot Be Edited

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) 349-4584
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94112
CAPACITY:14CENSUS: 9DATE:
06/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Jessica ArmentaTIME COMPLETED:
01:30 PM
NARRATIVE
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Licensing Program Analyst, LPA Yee conducted a Required - 1-year inspection today. The purpose of the inspection was explained. Present at the facility are licensee, Jessica, 2 helpers and 9 children (2 are Jessica's children). LPA toured the facility with Jessica. Daycare areas(upper level): living room, dining room, bedroom #1 (front) for napping only, hallway bathroom and the backyard. LPA verified the fingerprint clearance with Jessica. She said the information on the sheet is correct. Current residents are Jessica, her husband, her grand-mother (not here), and their children ages 6 years old, 3 years old and 1.5 years old. Days and hours of operations are from Monday - Friday, 8:00 a.m. - 5:00 p.m.
The home is equipped with a smoke detector, a carbon monoxide detector, and a fully charged fire extinguisher. The licensee and helpers have current CPR & 1st aid until 3-2023, 11/2023. During the inspection, LPA reviewed the staff file and children's files. One of the staff immunization is not available. Jessica said she misplaced the records and will have the staff request a new one for her file. The roster is available. The licensee has Child Abuse Mandated Reporter Training, AB1207 certificate on file, completed on 6/3/22. Both helpers need to complete the Child Abuse Mandated Reporter Training. Jessica said she will have them complete the training and will submit by the end of this month. The last emergency drill was conducted on 5/27/22. The documentation sheet is on file.
LPA discussed the safe sleep regulations with the licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. Infant sleep chart was provided.

Website: www.ccld.ca.gov. Title 22, Div 12, Chp 3
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 06/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/08/2022
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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