414001251-10-18-2019-05-CC-GSIH-BH3NVX-20191018104840

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414001251
Report Date: 10/18/2019
Date Signed: 10/18/2019 10:48:46 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:	BROWN, RUTH M.		FACILITY NUMBER:	414001251
ADMINISTRATOR:	BROWN, RUTH M.		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 368-9914
CITY:	REDWOOD CITY	STATE: CA	ZIP CODE:	94061
CAPACITY:	14	CENSUS:	DATE:	10/18/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Ruth Brown & Danielle Griffith		TIME COMPLETED:	11:00 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	Licensing Program Analyst (LPA) Singh met with licensee, Ruth Brown, for an annual random inspection. The purpose of the inspection was explained. Licensee lives in a single family home. Present, there are 13 children ( One infant, 11 pre school age and one school age) in care with licensee and one helper. All adults living or working in the home have criminal background check on file. Licensee is operating within the capacity of this date. Licensee provides day care from Monday to Friday between 7:15 AM to 6 PM. LPA inspected the day care areas with the licensee. Day Care Areas: Living Room, Day care room, Kitchen, Dining area, Bathroom and Backyard. Off limit areas: Master Bedroom, Bedroom # 1, Bedroom # 2, Bathroom and Garage. There is no pool, spa or any other body of water in the house. As per licensee, there is no firearm or weapon in the house. Licensee has two dogs in the house. Fireplace is barricaded. All the cleaning supplies, poisons and other chemicals are stored inaccessible to the children. Cabinets in bathroom and kitchen have child protective locks in place. The house is in good repair and free of hazards with proper temperature and ventilation. There is carbon monoxide detector, smoke detector, fully charged fire extinguisher and working telephone available in the house. There is a variety of age appropriate toys in the house. At 10:10 AM, LPA review the records. Licensee has all of the required documents posted and are visible for the public. LPA reviewed the identification and emergency information form for every child for proper names and numbers filled. Licensee has immunization record of all of the children in care. Licensee has record of training of preventive health and CPR card valid until November 2019. Licensee stated that she has signed up for renewal of the training. Record of immunization of licensee and the helper was checked during previous inspection. Licensee has completed the Mandated reporter training on August 13, 2018. Licensee’s helper also has completed the training. The training can be obtained online at www.mandatedreporterca.com. See next page for continuation .....................

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Gagandeep Singh	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2019

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: BROWN, RUTH M.	FACILITY NUMBER: 414001251
	VISIT DATE: 10/18/2019

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Continuation from previous page ....................

LPA discussed the safe sleep regulation concepts and a handout was provided. LPA encourage the licensee to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. LPA discussed the effects of lead exposure and provided a handout.

No deficiencies are cited today. The copy of this report is reviewed and provided to the licensee. Notice of site visit is posted and shall remain posted for next 30 days.

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Gagandeep Singh	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2019

LIC809 (FAS) - (06/04)

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