414000100-9-20-2022-05-CC-CQUO-CJFP7L-20220920110405

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414000100
Report Date: 09/20/2022
Date Signed: 09/20/2022 11:04:47 AM

Document Has Been Signed on 09/20/2022 11:04 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:	NAVA, PAULETTE & RICHARD		FACILITY NUMBER:	414000100
ADMINISTRATOR:	NAVA, PAULETTE & RICHARD		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 346-2393
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94403
CAPACITY:	12	CENSUS: 0	DATE:	09/20/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Paulette Nava		TIME COMPLETED:	11:15 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 September 20, 2022 at approximately 9:00am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, annual inspection. LPA met with licensee, Paulette Nava, and explained the purpose of the inspection. At time of LPA's visit, no enrolled children or other staff members were present. Licensee operates an after school, Montessori program in two separate groups. First group occurs with Kindergarteners from approximately 12:30pm to 3:00pm. Second group occurs with older school age children from approximately 3:00pm to 6:00pm. All individuals living and/or working in the home have fingerprint clearance on file. Licensee owns the home which is a multi-level home. The DAY CARE AREAS are the living room, dining room, garage (playroom), bathroom #1 (at the end of the hallway), bathroom #2 (located in dining room), front yard, side yard and backyard. The OFF-LIMITS AREAS are the entire second level of the home, bedrooms (converted to offices) located on first level of the home, and kitchen. All off limit areas are properly barricaded with child safety gates and/or locked doors. With licensee, LPA inspected day care areas for health and safety hazards. LPA observed home to be clean, in good repair with proper temperature and ventilation. All cleaning supplies, poisons, and other chemicals were made inaccessible to children, behind locked closets and cabinets. There were a variety of age appropriate toys and equipment that were in good condition. LPA observed large cabinets in day care areas to be earthquake proof and securely fastened. Entire backyard is enclosed with an at least 5ft high fence. Yard includes an above ground fish pond that is properly barricaded and covered. The backyard is equipped with appropriate outdoor toys and materials that were in good working condition. Backyard also contains a climbing structure that was observed to be age appropriate and have resilient padding underneath. (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: 09/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2022

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: NAVA, PAULETTE & RICHARD	FACILITY NUMBER: 414000100
	VISIT DATE: 09/20/2022

NARRATIVE

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Outdoor area also includes a chicken coop that was observed to be clean and properly barricaded and locked.

There was a smoke and carbon monoxide detector, fully charged fire extinguisher and working telephone on site. Phone number listed for licensee is current. Per licensee, there are no weapons or firearms in the home.

LPA reviewed ten random children's records which were complete. Children's records have a record of emergency identification information on file. LPA reviewed licensee's file which was also complete with required immunizations that were made available for review. Licensee has a current and valid CPR certificate that will expire 05/2024.

Emergency drills are conducted at least once every six months and are properly logged and documented. Last emergency disaster drill was conducted 09/14/2022.

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 Family Child Care Homes Section 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 publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://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: 09/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2022

LIC809 (FAS) - (06/04)

Page: 3 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: NAVA, PAULETTE & RICHARD	FACILITY NUMBER: 414000100
	VISIT DATE: 09/20/2022

NARRATIVE

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Licensee 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 licensee 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 licensee 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 maintain postings will result in an immediate $100 civil penalty.

Exit interview conducted and report was reviewed with the licensee, Paulette Nava.

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2022

LIC809 (FAS) - (06/04)

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