410509233-10-29-2019-05-CC-GSIH-BHEQPP-20191029122105

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 410509233
Report Date: 10/29/2019
Date Signed: 10/29/2019 12:21:10 PM

COMPREHENSIVE INSPECTION

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:	DI BENE, DIANE & LOUIS		FACILITY NUMBER:	410509233
ADMINISTRATOR:	DI BENE, DIANE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 574-4565
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94403
CAPACITY:	12	CENSUS: 6	DATE:	10/29/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:50 AM
MET WITH:	Diane & Lynn Di Bene		TIME COMPLETED:	12:30 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 (LPA), Singh, met with licensee, Diane Di Bene, and helper, Lynn Duri, for an annual random inspection. The purpose of the inspection was explained. Licensee lives in two story home. Present, there are six children (four infants, two pre school age) in care with licensee and one helper. All adults living or working in the home have criminal background check on file. Licensee is operating within the capacity of this date. LPA inspected the day care areas with the helper. Day Care Areas: Living Room, Kitchen, Bathroom, Bedroom, Garage, Outside deck and Backyard. Off limit areas: One bedroom on ground floor and entire second floor. There is no pool, spa or any other body of water in the house. As per licensee, there is no firearm or weapon in the house. Stairs inside the house and in backyard has child protective gates installed. Fireplace is barricaded. All the cleaning supplies, poisons and other chemicals are stored inaccessible to the children. There are no pets in the house. The house is in good repair and free of hazards with proper temperature and ventilation. There are multiple carbon monoxide detectors, smoke detectors and fully charged fire extinguishers in the house. There is working telephone available in the house. Licensee has sufficient amount of cribs available. All bedding equipment is properly sanitized and in good repair. There is a variety of age appropriate toys in the house. At 11:45 AM, LPA review the record. LPA observed licensee has all of required documents posted and visible for public. LPA reviewed the identification and emergency information form for every child for proper names and numbers filled. Licensee has record of each child’s immunization. Licensee has record of training of preventive health and CPR card valid until June 2021. Per helper, fire and emergency drills are being done every month and are documented on the calendar. See next page for continuation ............

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Gagandeep Singh	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/29/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2019

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 2

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: DI BENE, DIANE & LOUIS	FACILITY NUMBER: 410509233
	VISIT DATE: 10/29/2019

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
26
27
28
29
30
31
32

Continuation from previous page ...........

LPA reminded licensee that a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles. LPA review AB 1207 with the Licensee. As of January 1, 2018, all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

LPA encourage the licensee to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. Licensee can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

No deficiencies are cited today. The copy of this report is reviewed and provided to the helper. Notice of site visit is posted and shall remain posted for next 30 days.

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Gagandeep Singh	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/29/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2019

LIC809 (FAS) - (06/04)

Page: 2 of 2