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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410518955
Report Date: 07/23/2019
Date Signed: 07/23/2019 11:05:04 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:ROE, CATHERINE - "COTTAGE BY THE SEA CHILD CARE"FACILITY NUMBER:
410518955
ADMINISTRATOR:ROE, CATHERINE M.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 728-1816
CITY:MOSS BEACHSTATE: CAZIP CODE:
94038
CAPACITY:12CENSUS: 10DATE:
07/23/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Catherine RoeTIME COMPLETED:
11:30 AM
NARRATIVE
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3, Licensing Program Analyst, LPA Yee conducted an annual random inspection today. There are 10 children, licensee, Catherine, and her helper, Lilian present today. The purpose of the inspection was explained. The facility personnel summary report was reviewed with Catherine and she said it's correct. Catherine is the only person that lives at this facility. Day-care areas: living room, kitchen, bedroom, bathroom, patio, and outdoor play yard. The main house area is off-limit to children. Sandbox located in the outside yard is covered when not in use and the sandbox is checked every morning prior to children going outside. The home is equipped with a smoke detector, carbon monoxide detector, and a fire extinguisher. Children toys and equipment appears to be safe and in good condition. Current CPR and 1st aid certificate are not available. However, Catherine is renewing the class on August 4th, confirmation letter was verified during the inspection. Required staff immunization is on file. This facility provides Incidental Medical Services - IMS. LPA reviewed storage of medication and equipment/supplies and reviewed children's, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 102417. 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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, Available at http://www.ada.gov/childqanda.htm. A written IMS will be submitted by the end of this month. LPA discussed the Mandated Reporter Training, AB1207 that was effective on 1/1/2018. All staff must take the training and keep the certificate on file. The training needs to be renewed once every 2 years.
Child Abuse Mandated Reporter Training, AB1207. https://www.mandatedreporterca.com/ Children files were reviewed. SIDS "A Child Care Provider's Guide to Safe Sleep" was explained and provided.

website: www.ccld.ca.gov. Title 22, Division 12, Chapter 3.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2019
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: ROE, CATHERINE - "COTTAGE BY THE SEA CHILD CARE"
FACILITY NUMBER: 410518955
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/23/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/23/2019
Section Cited
HSC
1596.8662(b)(5)
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1596.8662(b)(5) On and after January 1, 2018, a person who becomes an administrator or employee of a licensed child day care facility shall complete the mandated reporter training. All staff members need to take Mandated Reporter Training.
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The facility needs to correct this deficiency by due date.
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Licensee and staff do not have the required mandated child abuse training as mandated by AB 1207.

This requirement was not met as evidence-based upon records review. This poses a potential health risk to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2019
LIC809 (FAS) - (06/04)
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