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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004143
Report Date: 11/07/2019
Date Signed: 11/07/2019 11:17:52 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:QUINONEZ,ANA PAULAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 912-0300
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94112
CAPACITY:12CENSUS: 8DATE:
11/07/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Ana Paula QuinonezTIME COMPLETED:
10:30 AM
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2, Licensing Program Analyst, LPA Yee conducted an annual random inspection today. There are 8 children (4 infants), licensee, Ana Paula, two helpers present today. Current residents are Ana Paula, two tenants and her children ages 15 yr old daughter, 12 yr old son. Ana's cousin Ana Dias does not live here. Ana Paula said Ana Dias has her own place now. Ana Dias currently has an FCCH application on file and in process. No change in the daycare areas. 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 last emergency drill was conducted on July-8-2019. A log sheet was available for a review. The home has age-appropriate toys and equipment available for the children in care. Required immunization for staff members is on file. The new helper needs to take Child Abuse Mandated Reporter training, AB1207. However, the helper is waiting for the Spanish version to become available. 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 incidental medical services plan is on file. SIDS " A Child Care Provider's Guide to Safe Sleep" information was provided. The facility provides snacks and lunches. All adults living at the facility have fingerprint clearance. Children's files were reviewed.

website: 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: 11/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2019
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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