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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004246
Report Date: 03/04/2020
Date Signed: 03/04/2020 09:47:02 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:VALDERRAMOS,KATERINE C.FACILITY NUMBER:
384004246
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
03/04/2020
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Katerine C. ValderramosTIME COMPLETED:
10:00 AM
NARRATIVE
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Licensing Program Analyst conducted a pre-licensing inspection today. I met with the applicant, Katerine Valderramos and her husband Juan and toured the facility with Katerine and Juan. The home is leased by the applicant. The lease agreement is on file. The home maintains three bedrooms, two bathrooms, living room, dining room #1, dining room #2, kitchen, garage and back yard. Daycare areas: dining room #1, dining room #2, hallway bathroom and the backyard. The remaining areas are off-limit. Current residents in the home are applicant, Katerine, her husband, Katerine's mother in law and their two children ages 12 and 7 years old. All adults living in the home have TB tests and criminal record clearance. Katerine has completed the required immunization (MMR, TDAP, Flu). The applicant has completed the required 16 hours of health and safety training to include pediatric CPR and first aid. The home is clean, safe, and has a working smoke detector, carbon monoxide detector, fire extinguisher, and telephone. The licensee maintains a first aid kit. Per the applicant, there are no weapons or guns in the home. Toys are clean, safe and age-appropriate. 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. 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/ Applicant said she will wait for the Spanish version. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Sections 102417. When any IMS is provided, a Plan for Providing 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. SIDS "A Child Care Provider's Guide to Safe Sleep" information was provided. Posting requirements has been discussed. A packet of records to be maintained was explained to the applicant.
Prior to licensure: 1) Stairs leading to the backyard needs to be inaccessible. 2) Landlord notification.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2020
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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