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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004143
Report Date: 07/02/2019
Date Signed: 07/02/2019 11:36:47 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:QUINONEZ, ANA PAULAFACILITY NUMBER:
384004143
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
07/02/2019
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Ana Paula QuinonezTIME COMPLETED:
12:00 PM
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Licensing Program Analysts, LPAs Yee, and Bremer conducted a pre-licensing inspection today. This is a change of location previously licensed at 183 Madrid Street, SF, CA. 94112 facility # 384003014. The facility is also applying for a large capacity. The fire clearance approval for large is on file. LPAs and Ms. Quinonez toured the entire home. The facility consists of 3 bedrooms, 2 baths, living room, daycare room #1, daycare room #2, kitchen, laundry room, patio, and backyard. Current residents are Ms. Quinonez, her cousin, and her children ages 14 yr old daughter, 11 yr old son. The lease agreement is on file. Daycare area: living room, daycare room #1, daycare room #2, kitchen, bathroom, and backyard. The remaining areas of the house are off-limits. The home is equipped with a smoke alarm, carbon monoxide detector, and fire extinguisher. The home has age-appropriate toys and equipment available for the children in care. Ms. Quinonez has been advised all adults, 18 yrs and older living in the home, or helper must have fingerprint clearance prior to having any contact with children in care. LPAs advised Ms. Quinonez that infant bouncer, saucer chair and similar items are not permitted in the daycare areas. 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 is on file. This facility plans to provide Incidental Medical Services - IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 102417. A Plan for Provides 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. Landlord notification is on file. Landlord consent is not on file. The facility can only care for 6 children without landlord approval. SIDS " A Child Care Provider's Guide to Safe Sleep" information was provided. Required immunization for both staffs is on file.

LPA will recommend a large license effective today, 7/2/19.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2019
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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