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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004316
Report Date: 09/10/2020
Date Signed: 09/15/2020 01:19:31 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:BAQUERO, ANGELA V.& CAMARGO, JOSE B.FACILITY NUMBER:
384004316
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
09/10/2020
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Jose B. CamargoTIME COMPLETED:
11:00 AM
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Due to COVID-19, a field inspection is suspended at this time. LPA Yee conducted a tele-inspection via Zoom today with the applicant's husband, Jose today.

This is a change of location. The facility was previously licensed at 1955 San Jose Avenue, SF, CA 94112, license # 384004158. There are no children in care today. Jose stated that they will finish moving to this location by this weekend. The home consists of 4 bedrooms, a daycare room, 3 bathrooms, a kitchen, a garage, a patio, and a backyard. Daycare areas (lower level): daycare room, room #2, bathroom, and backyard. Off limit areas: the entire upper level, patio, sister's room (lower level), and garage. Current residents in the home are Licensee, Angela Baquero, her husband Jose, her sister in law, Jose's 15 yr old son, and their infant child. The home is leased. The lease agreement is on file.
All adults living in the home have TB clearances and required immunization on file. The applicants have completed the required 16 hours of health and safety training to include pediatric CPR and first aid which expires 1/17/2022. The home is clean and safe. The licensee maintains a first aid kit. LPA discussed fire drills and emergency evacuation drills, which must be conducted and logged at least once every six months.

Prior to licensure the following items are needed: 1) red tape indicator on steps near the entry 2) cushion all sharp edges on the walls in daycare room, 3) install a gate on the stairs leading to the upper level 4) install gates on stairs that leading from patio to the backyard. 5) follow up inspection.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2020
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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