414001205-6-8-2022-05-CC-CQUO-CF7S96-20220608134011

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414001205
Report Date: 06/08/2022
Date Signed: 06/08/2022 01:41:07 PM

Document Has Been Signed on 06/08/2022 01:41 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:	WILSON, SANDRA & GONZALES, VERONICO		FACILITY NUMBER:	414001205
ADMINISTRATOR:	SANDRA W. & VERONICO G.		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 573-1565
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94403
CAPACITY:	14	CENSUS: 10	DATE:	06/08/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:20 AM
MET WITH:	Sandra Wilson		TIME COMPLETED:	01:50 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 June 8, 2022 at approximately 11:20am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, annual inspection. LPA met with licensee, Sandra Wilson, and explained the purpose of the inspection. Present in the home were both licensees, licensees' helper (H1) and 10 enrolled children (all preschool age). Licensees are operating within capacity limits and ratio on this date. All individuals living and/or working in the home have fingerprint clearance on file. Hours of of operation are Monday to Friday 8:00 to 5:30pm. Licensee owns the home which is a single-level, family home that includes 3 bedrooms, 2 bathrooms, living room, kitchen, backyard, and garage. The DAY CARE AREAS are the living room, bathroom #1, bathroom #2, master bedroom, backyard and garage. The OFF-LIMIT AREAS are bedroom #2 and bedroom #3. With licensee, LPA inspected day care areas for health and safety hazards. Home operates as a Montessori program. 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 child safety locked cabinets or facility's high shelves. Home is fully equipped with a variety of age appropriate Montessori materials and toys. Entire backyard is enclosed with an at least 5ft high fence. LPA did not observe home to have any pools, spas or bodies of water on the property. The backyard is equipped with appropriate outdoor toys and equipment that were in good working condition. The backyard floor is cushioned with resilient padding. Home has multiple smoke and carbon monoxide detectors, multiple fire extinguishers and a working phone on site. Phone number listed is current. Per licensee, there are no weapons or firearms in the home. (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: 06/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2022

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: WILSON, SANDRA & GONZALES, VERONICO	FACILITY NUMBER: 414001205
	VISIT DATE: 06/08/2022

NARRATIVE

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LPA reviewed twelve children's records which were complete. Children's records have a record of emergency identification information on file. LPA reviewed both licensees and H1's records, which were also complete. Licensees and H1 have proof of required immunizations that were made available for review during inspection. Licensee has a current and valid CPR certificate that will expire 08/2022. Emergency drills are conducted at least once every six months and are properly logged and documented. Last emergency disaster drill was conducted 05/22/2022.

During inspection:
- Licensee was given information regarding PIN 20-24-CCP Safe Sleep Regulation and Lead Poisoning Facts Flyer.
-Licensee was reminded, as of September 1, 2016, all Staff and Volunteers must provide proof of immunization against pertussis, measles, and influenza, or qualifies for an exemption, pursuant to Health and Safety code 1596.7995 and 1597.622.
-Licensee was reminded about Mandated Reporter training available on CCLD website. Training must be completed every 2 years by all staff hired. Training can be taken online at www.mandatedreporterca.com.
-Licensee was reminded about the Provider Information Notices (PINs) on CCLD website.
-Licensee was advised for any additional questions to contact CCLD office, Monday to Friday, 8:00am - 5:00pm, (650) 266-8800 or 1 (844) 538-8766. Website: www.cdss.ca.gov.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. 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: 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: 06/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2022

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: WILSON, SANDRA & GONZALES, VERONICO	FACILITY NUMBER: 414001205
	VISIT DATE: 06/08/2022

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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.

An exit interview conducted and report was reviewed with the licensee, Sandra Wilson.

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2022

LIC809 (FAS) - (06/04)

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