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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004316
Report Date: 09/01/2021
Date Signed: 09/01/2021 10:40:47 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:BAQUERO, ANGELA V.FACILITY NUMBER:
384004316
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 5DATE:
09/01/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Angela BaqueroTIME COMPLETED:
11:00 AM
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Licensing Program Analyst, LPA Yee conducted an annual inspection today. Present at the facility are the licensee, Angela, and 5 daycare children. The purpose of the inspection was explained. The entire upper level is off-limit. Daycare areas (lower level): daycare room, room #2, room #1, bathroom, and backyard. Licensee requested to add room #1 to be part of the daycare. LPA inspected the room and approved during the inspection. Current residents in the home are Licensee, Angela Baquero, her husband Jose, Jose's 16 yr old son, and their 2 years old daughter. Licensee has current pediatric CPR and first aid which expires 1/17/2022. The daycare is clean and safe. The last emergency drill was conducted in July. Children's files were reviewed. The facility personnel summary report was reviewed with the licensee and she said it's current. The facility provides meals. The safe sleep concept was reviewed with the licensee's husband on the phone. Licensee speaks limited English. Husband helps with the translation. A copy of the capacity worksheet was provided during the inspection. LIC9227 "Individual Infant Sleeping Plan" was provided. The provider shall supervise infants while sleeping, document and maintained in the infant's file. The documentation shall include the date, infant's name, time of each 15-minute check.

Website: ccld.ca.gov Title 22, Div 12, Chp3
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2021
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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