<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410518784
Report Date: 10/22/2019
Date Signed: 10/22/2019 10:39:47 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:CAPOVILLA, LUCYFACILITY NUMBER:
410518784
ADMINISTRATOR:CAPOVILLA, LUCYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 703-5454
CITY:SAN MATEOSTATE: CAZIP CODE:
94402
CAPACITY:14CENSUS: 6DATE:
10/22/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Lucy CapovillaTIME COMPLETED:
11:00 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
Licensing Program Analyst (LPA) Faye Bremer conducted an unannounced Annual inspection. LPA met with Licensee Lucy Capovilla and explained purpose of inspection. There were 6 children with one additional staff working with Licensee upon LPAs arrival.

LPA toured and inspected the physical plant, inside and out, for any health and safety hazards. Home is a 3 bedroom, 1 bathroom, single story unit. Daycare Areas are: Family room, bathroom, master bedroom #1 and # 2 used for napping only, and backyard. Licensee informed LPA that she also utilizes the park located across the street. Off Limit Areas are: Front living room and dining room which are only used to transition the children to the daycare areas, kitchen, bedroom # 3, and garage. Off limit areas are properly barricaded. Home was observed to be clean and orderly, at a comfortable temperature, and with sufficient lighting and ventilation. Home is observed to have sufficient age appropriate toys and furniture, in good repair, for children indoors and outdoors. Home has a working smoke and carbon monoxide detector, and a fully charged fire extinguisher that meets the minimum requirements. There are no bodies of water. Fireplace in the off-limits front living room is properly barricaded. There are no poisons, detergents, cleaning products, or sharp objects accessible to children. Licensee states there are no guns or weapons in the home. Fire drills are conducted and logged, with last fire drill conducted on 10/04/19. Licensee stated that parents provide meals. Discipline policy is time out. Licensee is advised of the time out regulation, 1 minute per age of the child.

LPA reviewed children and staff files. All children's files reviewed are complete, with all required assessments and agreements. Licensee’s CPR expires in 1/2021, and Mandated Reporter training taken on 03/07/2018.

No deficiencies cited today.
Report reviewed, discussed and provided to Licensee Lucy Capovilla
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Faye BremerTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2019
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 1