414001460-4-22-2022-05-CC-CQUO-CDQPSU-20220422113452

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414001460
Report Date: 04/22/2022
Date Signed: 04/22/2022 11:35:32 AM

Document Has Been Signed on 04/22/2022 11:35 AM - 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:	ALVARADO, EVELIN VERONICA		FACILITY NUMBER:	414001460
ADMINISTRATOR:	ALVARADO, EVELIN VERONICA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 570-7247
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94403
CAPACITY:	14	CENSUS: 8	DATE:	04/22/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Evelin Alvarado		TIME COMPLETED:	11:35 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	On April 22, 2022 at approximately 9:00am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, annual inspection. LPA met with licensee, Evelin Veronica Alvarado, and explained the purpose of the inspection. Present during inspection included licensee, licensee's spouse, and 6 enrolled children (2 infants and 4 preschool age). Licensee is operating within capacity limits and ratio on this date. All adults living and or working in the home have fingerprint clearance on file. Hours of operation are Monday to Friday from 7:30am to 5:30pm. Licensee owns the home with licensee's spouse. Home is a single-level family home that includes three bedrooms, living room, kitchen, dining room, bathroom, day care room, patio, backyard and garage. The DAY CARE AREAS currently being used are the patio (located in the back of the home), bathroom, and day care room (napping room only). The OFF-LIMIT AREAS are three bedrooms, living room, kitchen, dining room and garage. With licensee, LPA inspected day care areas currently in use. LPA observed home to be in good repair with proper temperature and ventilation. At approximately 9:25 am, additional preschool age child arrived to facility. LPA observed there were a variety of age appropriate toys and equipment in the home which were in good condition. All cleaning supplies, poisons and other chemicals were stored inaccessible to children on facility's high cabinets, shelves or locked behind child safety locked cabinets. At approximately 9:30am, additional preschool age child arrived to facility. Present during inspection included 8 enrolled children (2 infants and 6 preschool age children). There were no pools, spas or bodies of water on the property. The entire backyard is enclosed with an least 5ft high fence. Backyard is equipped with appropriate outdoor toys and equipment that were in good, clean, working condition. (Continue 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: 04/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2022

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: ALVARADO, EVELIN VERONICA	FACILITY NUMBER: 414001460
	VISIT DATE: 04/22/2022

NARRATIVE

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There was a combination smoke and carbon monoxide detector, fully charged fire extinguisher and a working telephone on site. Phone number listed for licensee is current. Per licensee, there are no weapons or firearms in the home.

LPA reviewed eleven children's records which were complete. Children's files have a record of emergency identification information on file. LPA reviewed licensee and licensee's spouses files which were also complete. Licensee and licensee's spouse have record of required immunizations available for review. Both licensee and licensee's spouse have valid Pediatric First Aid/CPR certificates that will expire 03/2023. Emergency drills are conducted at least once every six months and are properly logged. Las emergency drill was conducted 04/01/2022. Licensee has required licensing documents posted near facility entry.

During Inspection:
- Licensee was given information regarding annual fees 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.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm

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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: 04/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2022

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: ALVARADO, EVELIN VERONICA	FACILITY NUMBER: 414001460
	VISIT DATE: 04/22/2022

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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.

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, Evelin Veronica Alvarado.

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2022

LIC809 (FAS) - (06/04)

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