414001460-11-29-2023-05-CC-JTSE-CY2SVN-20231129131302

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414001460
Report Date: 11/29/2023
Date Signed: 11/29/2023 01:13:26 PM

Document Has Been Signed on 11/29/2023 01:13 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
SAN BRUNO CC RO, 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: 11	DATE:	11/29/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Licensee, Evelin Alvarado		TIME COMPLETED:	01:30 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 11/29/2023, at approximately 10:45AM, Licensing Program Analyst (LPA) Jonathan Tse conducted an unannounced annual inspection. LPA was granted entry to the facility by Licensee, Evelin Alvarado. LPA explained the purpose of the visit. Present in the facility were Licensee, Licensee’s spouse, three infants and eight preschool age children. The facility is in compliance with capacity requirements. The facility’s normal operating hours are from 8:30AM to 5:30PM. The home is a single-level three-bedroom, two-bathroom home. DAY CARE AREAS: Patio (converted for use as Daycare Area), Bathroom #2 and Yard. OFF-LIMIT AREAS: Bedroom 1, Bedroom 2, Bedroom 3, Bathroom #1, Kitchen, Living Room, Family Room, Garage. LPA inspected the home for any health and safety hazards. The home is kept in clean and orderly condition. Children are signed in and out via a sign-in/out sheet. There are age-appropriate toys and learning equipment in the Daycare Area for children. LPA observed cribs to be available for infant use. LPA observed a carbon monoxide detector and smoke detector to be operational. There is a fire alarm system running through the home. The home is equipped with a fully charged 3A40BC fire extinguisher. Cleaning supplies, poisons and other chemicals are stored inaccessible to children. All outlets are covered or obstructed by furniture to not be accessible to children. There is no fireplace in the daycare areas. All off-limits areas are barricaded and kept inaccessible to children. Per Licensee, there are no firearms kept in the home. The yard is kept in clean condition. LPA did not observe any debris or other loose material to be present. There is sufficient cushioning for children. There is a storage unit located in the backyard that is off-limits and is kept locked to be inaccessible to children. The play equipment in the yard was observed to be clean and in good repair. There is a fence enclosing the yard that is at least five feet high. The yard is cleaned daily. There are no pools or other bodies of water located in the facility. Continued on Page Two

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Jonathan Tse	TELEPHONE: (650) 464-4927
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023

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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: ALVARADO, EVELIN VERONICA	FACILITY NUMBER: 414001460
	VISIT DATE: 11/29/2023

NARRATIVE

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Page Two
LPA reviewed two staff files and ten children’s files. All children’s files included Identification and Emergency Information (LIC700), and Consent for Medical Treatment (LIC627). Licensee’s First Aid/CPR Training expires 3/2025. Licensee’s Mandated Reporter Training expires 9/2025. LPA discussed requirement to maintain Mandated Reporter Training for all adults who work in the home. LPA discussed requirement to maintain proper documentation in all employee’s files.

LPA observed the following documents to be posted: Facility License and PUB394, Notification of Parents’ Rights. The last emergency drill conducted was on 10/19/2023. Emergency drills are logged and documented properly. The facility prepares breakfast, lunch, and AM/PM snacks for children.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days 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-andresources/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.

Continued on Page Three

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Jonathan Tse	TELEPHONE: (650) 464-4927
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023

LIC809 (FAS) - (06/04)

Page: 5 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: ALVARADO, EVELIN VERONICA	FACILITY NUMBER: 414001460
	VISIT DATE: 11/29/2023

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

There are no deficiencies cited today. See LIC9102-TV for Technical Violations issued today.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Evelin Alvarado.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Jonathan Tse	TELEPHONE: (650) 464-4927
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023

LIC809 (FAS) - (06/04)

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