<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004246
Report Date: 07/07/2021
Date Signed: 07/07/2021 02:31:33 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:VALDERRAMOS,KATERINE C.FACILITY NUMBER:
384004246
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 3DATE:
07/07/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Katerine ValderramosTIME COMPLETED:
02:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst conducted a case management inspection today. Present at the daycare are the licensee, Katerine Valderramos, and three children. One left during the inspection. Total in care at the facility is now 2 children. The home is leased by the licensee. The lease agreement is on file. Landlord consent is on file. The home consists of three bedrooms, two bathrooms, a living room, dining room #1, dining room #2, kitchen, garage, and back yard. Daycare areas: living room, dining room #1, dining room #2, bedroom #3, kitchen, hallway bathroom, and the backyard. Off limit areas: bedroom #2, bedroom #1 (master bedroom with bathroom), garage. Current residents in the home are the licensee, Katerine, and her husband. All adults living in the home have criminal record clearance. CPR and first aid are current until August 2, 2021. LPA informed the licensee to renew her CPR,1st aid by the due date. 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 licensee, there are no weapons or guns in the home. Toys are clean, safe, and age-appropriate. The home is clean and ventilated properly. The last emergency drill was conducted in December-2021. The licensee said she will conduct one this month. Child Abuse Mandated Reporter Training, AB1207 certificate is on file and expires on 4/10/2023. The licensee has Lead Poising Prevention, LPP certificate is on file. Provider's Guide to Safe Sleep" information was discussed and LIC9227 was provided. Fire clearance, STD 850 was requested on 6/25/2021. The facility will provide snacks and lunches. The capacity worksheet was discussed and provided. LPA informed the licensee that when operating a large daycare, the facility needs two staff members at all times. She said she understands. An alarm on the exit door near the kitchen is recommended.

Prior to licensure: 1) fire clearance approval is needed 2) Renew CPR, 1st aid.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1