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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414000300
Report Date: 01/07/2020
Date Signed: 01/07/2020 04:37:33 PM

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:AGUADO, SUSAN & CARMICHAEL, CHRISTINEFACILITY NUMBER:
414000300
ADMINISTRATOR:S. AGUADO & C. CARMICHAELFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 572-2411
CITY:SAN MATEOSTATE: CAZIP CODE:
94402
CAPACITY:12CENSUS: 12DATE:
01/07/2020
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Co-Licensee, Christine CarmichaelTIME COMPLETED:
04:50 PM
NARRATIVE
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Licensing Program Analyst (LPA), Cindy Interiano, met with Co-Licensee, Christine Carmichael. Licensee Susan Aguado was also present during the inspection. Purpose of the inspection was explained and was for an Annual/Random inspection. Present in the facility is Licensee and 3 Helper caring for 12 children (4 infants and 8 PreK age). Licensee owns home and lives with Husband, 2 Adults, and minor son. Home is a 5 bedroom, 2.5 bathroom, two level house. Facility was inspected and the Daycare areas are: lower level: Playroom, Family Room, Dining area, Bathroom #0.5, and portion of the backyard. Off limit areas are: lower level: Front yard, Garage, Kitchen, Living Room, entire upper level: Bedroom #1-5, Bathrooms #2-3.All off limit areas, including closets are properly barricaded. Swimming pool in the backyard is secured with a pool cover and maintained off limits to children. LPA observed the following: Daycare area is clean, orderly, and equipped with age appropriate toys and equipment for the children. Home has sufficient lighting and ventilation. Home has a working telephone, a working smoke and carbon monoxide detector, and a fully charged fire extinguisher. Home does not have a chimney or bodies of water. There are no poisons, detergents, or cleaning products accessible to daycare children. Licensee states there are no guns or weapons of any kind in the home. Licensee's CPR has since expired. Licensee conducted last emergency drill on 12/06/19 and is properly logged. Licensee provides daily snacks and meals. Discipline policy is mainly redirection. All required postings are properly posted. Licensee have required proof of immunization on file. Licensee has Mandated Reporter Training certificate on file. Children’s roster was reviewed and it is complete and up-to-date.

See Page 2. . .
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2020
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 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: AGUADO, SUSAN & CARMICHAEL, CHRISTINE
FACILITY NUMBER: 414000300
VISIT DATE: 01/07/2020
NARRATIVE
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Page 2. . .

During inspection,
*Incidental Medical Services (IMS) policy was discussed.
*Licensee was reminded about having all Staff and Volunteers provide proof of immunization against influenza, pertussis, and measles or qualifies for an exemption.
*Licensee was reminded about the Provider Information Notices (PINs) on CCLD website.
*Licensee was reminded about Mandated Reporter Training available on CCLD website
(www.ccld.ca.gov or www.mandatedreporterca.com). Licensee states her Helpers will wait until training is available in Spanish.
*Licensee was advised of the new Lead Bill (effective 01/01/19), requiring Facilities to distribute a two-page flyer to Guardians with information on lead poisoning facts.
*Licensee was given information regarding ‘Safe Sleep’ practices.

>See attached page for deficiencies issued today under Title 22 Division 12 of the Ca. Code of Regulations.

>This report and rights to comment and appeal were discussed with Licensee. This report must be available in the facility for public review. Notice of site visit was observed being posted.
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
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2020
LIC809 (FAS) - (06/04)
Page: 2 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: AGUADO, SUSAN & CARMICHAEL, CHRISTINE
FACILITY NUMBER: 414000300
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/07/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/21/2020
Section Cited

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102416(c) Personnel Requirements - The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and
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pediatric first aid, pursuant to Health and Safety Code Section 1596.866.
This requirement was not met as evidenced by: Licensee not having current CPR training. This is a potential health and safety 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: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 01/07/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/07/2020
LIC809 (FAS) - (06/04)
Page: 3 of 3