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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004125
Report Date: 06/24/2021
Date Signed: 06/24/2021 12:16:12 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:RIVAS, AGUEDAFACILITY NUMBER:
384004125
ADMINISTRATOR:RIVAS, AGUEDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 994-2920
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94124
CAPACITY:14CENSUS: 8DATE:
06/24/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:28 AM
MET WITH:Agueda Rivas, Maria HuertaTIME COMPLETED:
11:55 AM
NARRATIVE
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Licensing Program Analyst (LPA) Andrea Medlin met with Licensee and helper for this annual visit. Purpose of visit explained. There are 8 children in care; 2 infants and 6 preschool aged. Days and hours of operation: Monday-Friday 8;00AM-5:00PM. Licensee states she, husband, two adults sons, and one minor daughter reside in the home; criminal record clearance is on file for all adults in the home. Physical plant toured to inspect for health and safety hazards in the licensed areas. The daycare has a fully charged fire extinguisher that meets the minimum requirements, smoke detectors, and a carbon monoxide (CO) detector in the daycare. First aid supplies are available. Detergents, cleaning compounds, medications, and other items which could pose a danger to children is stored inaccessible to children. The daycare area is kept clean and orderly and has adequate heating and ventilation for safety and comfort. Outdoor play area used for daycare is completely fenced. Per Licensee, there is one dog in the home. Per Licensee, there are no firearms or weapons in the home. No spas, swimming pools, hot tubs, fish ponds, or similar or bodies of water are present. Variety of age appropriate toys and materials is observed in the daycare. A sick child would be separated from the group and wait for parent to pick up. Staff and children's files reviewed. In the children's files reviewed, all have the Parent's Rights (LIC 995A) form and Identification and Emergency Information (LIC 700) on file. In the staff files reviewed, staff have verification of the mandated child abuse reporter training as compliant with AB1207; verification of the required immunizations: measels (MMR) and pertussis (Tdap); Licensee has current Pediatric First Aid and CPR (exp 2/2003) and helper (11/2021) training certification on file. All the required licensing forms are posted in a prominent accessible location.

This report is reviewed with program director and a copy of this report must be made available for public review upon request.

Notice of site visit posted and shall remain posted for 30 days
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Andrea MedlinTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2021
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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