410518784-9-27-2022-05-CC-LGOZ-CJNVDN-20220927162101

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 410518784
Report Date: 09/27/2022
Date Signed: 09/27/2022 04:21:09 PM

Document Has Been Signed on 09/27/2022 04:21 PM - 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:	CAPOVILLA, LUCY		FACILITY NUMBER:	410518784
ADMINISTRATOR:	CAPOVILLA, LUCY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 703-5454
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94402
CAPACITY:	14	CENSUS: 4	DATE:	09/27/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:55 PM
MET WITH:	Lucy Capovilla		TIME COMPLETED:	04:35 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	On 9/27/2022 at 1:55PM., Licensing Program Analyst (LPA), Luis J. Gomez met with Licensee, Lucy Capovilla. Purpose of the inspection was explained and was for an unannounced; annual random inspection. Present in facility was the licensee caring for four children (2 Preschool Age, 2 Infant Age). Present adults have their criminal record clearances on file. Licensee’s home is a three bedroom, two bathroom, one level house. Days and hours of operation are Monday- Friday, 7:00- 5:30pm. Day-care area are: Living Room (Playroom); Bedroom #1 (Napping Only); Bedroom #2 (Napping Only); Bathroom #1; and Backyard Area. Off-limit area are: Garage; Kitchen; and Dining Room (Pass through only). LPA inspected home, inside and outside, with licensee for health and safety hazards. At 2:05PM., the following was observed: Day-care was clean, orderly, with age appropriate playthings available for the children. Accessible furniture, puzzles and books are in good repair. Playroom has child sized table and bench for snack and planned activities. Playroom is equipped with cabinets, hangers and shelves for storage of children's belongings. For napping services, LPA observed napping mats and infant playpens stored in the facility. Licensee has at least one crib available (with tight-fitting sheet) for each infant in care. Bathroom#1 had adequate supplies for hand-washing, and fixtures tested were in operating condition. Accessible outlets and trash bins are covered. Facility was the proper temperature, with ventilation and lighting. Home had functioning telephone; smoke/ carbon monoxide detector combo; and one (fully charged) fire extinguisher, 3A:40BC. LPA inspected the outdoor play area. Per licensee, program no longer utilizes the backyard area. Licensee plans to remove the space from the on-limit areas. Backyard does not any pools, fishponds, or bodies of water on the premises. (REFER TO 809C FOR CONT)

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022

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: CAPOVILLA, LUCY	FACILITY NUMBER: 410518784
	VISIT DATE: 09/27/2022

NARRATIVE

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At 2:35PM, LPA reviewed the facility and children’s records. Children's records were reviewed and included the Identification of Emergency Information (LIC700); Immunization Records; and Notification of Parent’s Rights (LIC995A) and Infant Sleeping Plan for qualifying infants in care.

Licensee is maintaining documentation of infant napping conditions for each every 15- minute check.

Licensee’s Mandated Reporter Training Certification (AB1207) is current, expiring 2/6/2024.
Licensee’s Cardiopulmonary Resuscitation (CPR)/ First Aid certification is current, expiring: 01/2023.

Licensee is conducting required emergency disaster drill, with last drill completed on 8/26/2022, properly logged.

Required posting are posted in visible location. Posting include the Childcare License, Notification Parent’s Rights (PUB379), and Emergency Disaster Plan (LIC610A).

Per licensee, isolation of ill children is in playroom.

Per licensee, families provide foods services for children in care. LPA reminded licensee to ensure all children’s food containers brought by families is properly labeled. Per licensee, her home does not have any firearms or weapons.

Licensee was reminded that all adults 18 years and over, living or working in the home, including employee and volunteers, must obtain criminal 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.

(REFER TO 809C, FOR CONT.)

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022

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: CAPOVILLA, LUCY	FACILITY NUMBER: 410518784
	VISIT DATE: 09/27/2022

NARRATIVE

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LPA discussed the safe sleep regulations with licensee and discussed Child Care Licensing Safe Sleep Web page at:https://www.cdss.ca.gov/inforesource/child-care-licesning/public-information-and-resources/safe-sleep as an additional resource. LPA informed licensee of the importance of checking for recalled infant devices on United States consumer Product Safety Commission (CPSC) website at http://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

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 tool, please send them 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/inforesource/community-care-licensing/inspection-process.

Based on today's inspection, no deficiencies were observed in areas evaluated according to California Title 22, Health and Safety Code of Regulations. Exit interview and report was discussed with Licensee, Lucy Capovilla, and signature of this form acknowledges receipt of these documents.

Notice of Site Visit was provided and must be posted for 30 days.

This report must be available in the facility for public review. Licensee was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766.

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022

LIC809 (FAS) - (06/04)

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