410509233-8-31-2022-05-CC-CQUO-CHTNQ8-20220831103929

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 410509233
Report Date: 08/31/2022
Date Signed: 08/31/2022 10:40:09 AM

Document Has Been Signed on 08/31/2022 10:40 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:	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:	08/31/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:20 AM
MET WITH:	Diane Di Bene & Lynn Duri		TIME COMPLETED:	10:45 AM

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	On August 31, 2022 at approximately 8:20am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, annual inspection. LPA met with licensee, Diane Di Bene, and licensee's adult child, Lynn Duri. Present in the home included both licensees, licensee's adult child/assistant, and 6 enrolled children (3 infants and 3 preschool age). Licensees are operating within capacity limits and ratio during LPA's visit. All individuals living and/or working in the home have a criminal record clearance on file. Hours of operation are Monday to Friday from 7:30am to 4:30pm. Both licensees live in the home which is a multi-level, single family home. The DAY CARE AREAS located on the first level of the home include the living room, kitchen, bathroom, bedroom #1, bedroom #2, playroom #1, playroom #2 (garage), outside deck and backyard. The OFF-LIMIT AREAS are the entire second level of the home and shed located in backyard. Off limit areas are barricaded with child safety gates and/or locked doors. At approximately 8:30am, LPA toured day care areas of home with licensees' assistant. LPA observed home to be in good repair with proper temperature and ventilation. There were a variety of age appropriate toys and equipment that were in good condition. All cleaning supplies, poisons and other chemicals were stored inaccessible to children on facility's high shelves and/or locked behind child safety locked cabinets. There was a working smoke detector and carbon monoxide detector, fully charged fire extinguisher and a working phone on site. Phone number listed for licensees is current. Per assistant, there are no weapons or firearms in the home. LPA did not observe any pools, spas or bodies of water on the property. The entire backyard is enclosed with an at least 4 ft. high fence. LPA observed side gates and deck gate to be fully closed and locked. Backyard is equipped with appropriate outdoor toys and equipment that are in good working condition. LPA observed additional set of stairs located in backyard that was made inaccessible to children in care. (Continue Report on Page 2...)

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2022

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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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: 08/31/2022

NARRATIVE

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LPA reviewed seven children’s records which were complete. Children’s files have a record of emergency identification information on file. LPA reviewed both licensees and assistant's files which were also complete. Both licensees and assistant have a current Pediatric First Aid/CPR certificate that will expire 03/2024. Last emergency drill was conducted 08/15/2022. Emergency drills are conducted monthly and are properly logged in licensees' calendar.

During Inspection:
-LPA provided information regarding PIN 20-24-CCP Safe Sleep Regulation and Lead Poisoning Facts Flyer.
-LPA reminded, as of September 1, 2016, all Staff and Volunteers must provide proof of immunization against pertussis, measles, and influenza, or qualifies for an exemption, pursuant to Health and Safety code 1596.7995 and 1597.622.
-LPA provided information about Mandated Reporter training that can be taken online at www.mandatedreporterca.com. Training must be completed every 2 years by all staff hired.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) / (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: www.ada.gov/childqanda.htm.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process

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SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2022

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: 08/31/2022

NARRATIVE

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Licensees' assistant was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensees' assistant 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 licensees' assistant 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.

No deficiencies were cited today under CCR, Title 22, Div. 12, Chapt. 1.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

An exit interview conducted and report was reviewed with the licensees' assistant, Lynn Duri.

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2022

LIC809 (FAS) - (06/04)

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