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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414001409
Report Date: 09/11/2019
Date Signed: 09/11/2019 03:38:54 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:DIAZ, MARIA BETTINA C.FACILITY NUMBER:
414001409
ADMINISTRATOR:DIAZ, MARIA BETTINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 579-2678
CITY:SAN MATEOSTATE: CAZIP CODE:
94402
CAPACITY:14CENSUS: 4DATE:
09/11/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:25 PM
MET WITH:Maria Bettina DiazTIME COMPLETED:
03:45 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Faye Bremer and Wendi Wittmeyer conducted an unnannounced annual inspection. LPAs met with Licensee Maria Bettina Diaz and explained purpose of inspection. Upon LPAs' arrival, 3 infants and 1 preschool child were napping.

LPAs inspected the physical plant for any health and safety hazards. LPAs observed sufficient clean, age appropriate toys available to children. LPAs inspected the back yard and observed the backyard to have sufficient toys and structures to support gross motor activities.

Daycare Areas: kitchen, Living room, dining room, bathroom in garage area and backyard. Off Limit Areas: garage, three bedroom and bathroom. Off limits areas are made inaccessible by the use of child gates. There are no pools, spas or other bodies of water on the premises. Per the licensee, there are no firearms or weapons in the home. All cleaning supplies and other potentially harmful items are stored inaccessible to the the children. The fireplace is barricaded with a toy shelf. There is a fully charged 2A10BC fire extinguisher in the home. The home is equipped with smoke and carbon monoxide detectors. Stairs are barricaded with child gates. Licensee has a working land line telephone service. Licensee conducts emergency drills on the first of each month and documents each drill on a calendar. Safe Sleep handout was discussed and provided.

LPAs reviewed children's files. Children's files are complete, with all necessary signed forms, assessments and agreements on file. Licensee verified with LPAs that she does not have updated Mandated Reporter training. Licensee's CPR and First Aid is expired, expired on September 24, 2018. All staff have Criminal Record Clearances.

Continues on following page.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Faye BremerTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2019
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: DIAZ, MARIA BETTINA C.
FACILITY NUMBER: 414001409
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/11/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/18/2019
Section Cited

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Personnel Requirements - The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.
This requirement is not met as evidenced by:
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Based on review of documents, Licensee does not have updated pediatric 1st aid/CPR training. Licensee failed to ensure that all staff, including Licensee, complete training on preventive health practices, which poses a potential health and safety risk.
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Licensee shall submit certificate of completion, once training is completed.

POC to be received in CCLD office BY 9/18/2019

Type B
09/18/2019
Section Cited

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Availability of information regarding detecting and reporting child abuse and neglect; training for mandated reporter who is licensed day care provider, administrator, or employee of a licensed child day care facility; proof of completion-
On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
This requirement is not met as evidenced by:
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Based on Licensee's statement, Licensee does not have updated Mandated Reporter training. LIcensee failed to ensure that Mandated Reporter training is completed ever 2 years, which poses a potential health and safety risk.
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Licensee shall submit certificate of completion, once training is completed.

POC to be received in CCLD office BY 9/18/2019
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: Faye BremerTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 09/11/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/11/2019
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: DIAZ, MARIA BETTINA C.
FACILITY NUMBER: 414001409
VISIT DATE: 09/11/2019
NARRATIVE
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Continued from previous page.

Facility is not currently providing Incidental Medical Services (IMS). 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 facilities and the ADA, available at: http://www.ada.gov/childqanda.htm

Deficiencies cited today under California Code of Regulations, Title 22, Div 12, follows on LIC809D
Appeal Rights given.
Report reviewed and provided to Licensee Maria Bettia Diaz.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Faye BremerTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3