<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414001261
Report Date: 01/10/2020
Date Signed: 01/10/2020 03:20:04 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:OLIVARES, MAGDA O.FACILITY NUMBER:
414001261
ADMINISTRATOR:OLIVARES, MAGDA O.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 207-5083
CITY:MENLO PARKSTATE: CAZIP CODE:
94025
CAPACITY:14CENSUS: 10DATE:
01/10/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Licensee, Magda O. OlivaresTIME COMPLETED:
02:00 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
Licensing Program Analyst (LPA), Cindy Interiano, met with Licensee, Magda O. Olivares for a Required - 1 year inspection. Purpose of the inspection was explained. Upon arrival, present in the facility was 3 Helpers caring for 8 children (3 infants and 5 PreK). Licensee was on a Field trip at the Library with 2 PreK children. Licensee returned to the facility with 2 PreK children during inspection. Licensee has a signed Field trip form in children’s files. Vehicle is equipped with age appropriate car seats. Licensee owns home and lives with Husband and Adult Son. Home is a single level house with 3 bedrooms, 2 Bathrooms, and a detached Garage. Facility was inspected and Daycare areas are: Living Room, Bathroom #1, Bedroom #2, Bedroom #3, Dining/Play area, Front porch, and portion of the backyard. Off Limit areas are: Bedroom #1, Bathroom #2 (inside Bedroom #3), Laundry room, converted (detached) Garage and Storage unit in the backyard, portion of the Backyard, and driveway area. All off limit areas, including closets, are maintained properly barricaded. 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. Chimney in the living room is properly barricaded. Home has no bodies of water. There are no poisons, detergents, or cleaning products accessible to daycare children. Licensee states there are no guns/weapons in the home. Licensee’s CPR expires in 10/2020. Helper’s CPR are also on file. Licensee conducted last emergency drill on 09/09/19 and is properly logged. Licensee provides daily snacks and meals. Discipline policy is mainly redirection. All required postings are properly posted. Licensee and Helpers have required proof of immunization on file. Children’s roster and files were reviewed and are 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: 01/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2020
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 2
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: OLIVARES, MAGDA O.
FACILITY NUMBER: 414001261
VISIT DATE: 01/10/2020
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
26
27
28
29
30
31
32
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 and Helpers will take training once 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.

>No deficiencies were 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: 01/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2020
LIC809 (FAS) - (06/04)
Page: 2 of 2