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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410519074
Report Date: 08/13/2019
Date Signed: 08/13/2019 10:56:08 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:RODRIGUEZ, YATHMINFACILITY NUMBER:
410519074
ADMINISTRATOR:RODRIGUEZ, YATHMINFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 368-8948
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94063
CAPACITY:14CENSUS: 0DATE:
08/13/2019
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Licensee, Yathmin RodriguezTIME COMPLETED:
11:00 AM
NARRATIVE
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Regional Manager (RM), Suzanne Roman-Clark, Licensing Program Manager (LPM), Alma Malig, Licensing Program Analyst (LPA), Cindy Interiano, met with Licensee, Yathmin Rodriguez for a non-compliance meeting.

During Non-Compliance conference, Facility was cited a Type A for failing to call 911 when child was having the medical emergency. Licensee self reported incident in a timely manner.

***See attached page for deficiencies cited against the facility under CCR,Title 22, Div. 12, Chapt. 1.***

>This report and rights to comment and appeal were discussed with Licensee. 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. Website: www.cdss.ca.gov





Type “A” violations were issued today. Licensee is advised to provide a copy of the Evaluation Report and the Type “A” Deficiencies cited, to the parents and guardians of children currently enrolled in care and to parents of newly enrolled children during the next 12 months. A signed and dated LIC 9224 (Deficiency and Acknowledgment of Receipt of Licensing Reports) shall be maintained in all Children's files.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2019
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: RODRIGUEZ, YATHMIN
FACILITY NUMBER: 410519074
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/13/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/13/2019
Section Cited
CCR
102423(a)
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Personal rights:(a)Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from
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Licensee attended a Non-Compliance Conference on 08/13/19.
Child no longer attends daycare.
Licensee knows and understands to seek Medical attention when
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child's authorized representative.
This requirement was not met as evidenced by: based on Licensee not seeking professional medical attention shortly after an infant suffered a medical emergency on 04/08/19.
This poses an immediate safety risk to children in care.
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necessary, regardless of Guardian consent and/or objection.

Deficiency cleared.
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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: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2019
LIC809 (FAS) - (06/04)
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