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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004246
Report Date: 03/24/2022
Date Signed: 03/24/2022 11:15:04 AM


Document Has Been Signed on 03/24/2022 11:15 AM - It Cannot Be Edited

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:VALDERRAMOS,KATERINE CFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 627-7476
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94112
CAPACITY:14CENSUS: 8DATE:
03/24/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Katerine c. ValderramosTIME COMPLETED:
11:45 AM
NARRATIVE
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Licensing Program Analyst, LPA Yee conducted a Required - 1-year inspection today. The purpose of the inspection was explained. Upon arrival, LPA rang the doorbell. No respond. LPA called licensee, Katerine. Katerine answered the phone. Katerine said she is watering the plant, she is coming. Katerine arrived at the facility within 15 mins with her husband. LPA entered the facility with Katerine and her husband. Present at the daycare are 8 children(4 infants) and Katerine's mother-in-law, Yolanda. There was no helper present with Yolanda at the time. Yolanda is also a licensee at another FCCH facility. Katerine's husband said Yolanda is here to help because Yolanda's daycare is closed today. LPA toured the house with Katerine. Current residents are Katerine and her husband. The facility personnel summary report was reviewed with Katerine and she said it's current. Day Care Areas: living room, dining room, bathroom, bedroom #3, kitchen, dining room #2, and backyard. The remaining areas of the house are off-limits. The home is equipped with a smoke detector, a carbon monoxide detector, and a fully charged fire extinguisher. The licensee, CPR & 1st aid are current until 07/17/23. The facility provides meals for the children. The facility is on a food program. Child Abuse Mandated Reporter Training, AB1207 certificate is current, completed on 4/10/21. LPA reminded the licensee that the training needs to be renewed once every 2 years. Child Abuse Mandated Reporter Training, AB1207. www.mandatedreporterca.com. Liability insurance is on file. LPA discussed the safe sleep regulations with the licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed the licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. The roster was reviewed. "Individual Infant Sleep Plan", LIC9227 was on file for infants who are less than 12 months old. Infants were checked every 15 minutes and a log sheet was reviewed. FCCH capacity worksheet was explained and provided.

Website: www.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: 03/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/24/2022
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 4


Document Has Been Signed on 03/24/2022 11:15 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/24/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102416.5(d)
Staffing Ratio and Capacity
(d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 03/24/2022
Plan of Correction
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The licensee arrived at the facility. The facility now has 2 staff with 8 children. The deficiency is now cleared.
Type A
Section Cited
CCR
102416.5(e)
Staffing Ratio and Capacity
(e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 03/24/2022
Plan of Correction
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This is a large daycare. The facility did not have 2 staff members to supervised 8 children. The licensee arrived the facility within 15 mins. The deficiency is now cleared.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 03/24/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/24/2022
LIC809 (FAS) - (06/04)
Page: 2 of 4