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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414001633
Report Date: 12/22/2022
Date Signed: 12/22/2022 11:32:27 AM


Document Has Been Signed on 12/22/2022 11:32 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:CALVIO, LIGIA R.FACILITY NUMBER:
414001633
ADMINISTRATOR:CALVIO, LIGIA R.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 877-1570
CITY:SOUTH SAN FRANCISCOSTATE: CAZIP CODE:
94080
CAPACITY:14CENSUS: 5DATE:
12/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Ligia CalvioTIME COMPLETED:
11:50 AM
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Licensing Program Analyst (LPA) Andrea Medlin met with facility representative for this required annual licensing visit. Purpose of visit explained. Days and hours of operation: Monday-Friday 8:00AM-5:00PM. There are 5 children present during the visit; 3 infants and 2 preschool aged. Licensee states she, husband, one adult son, and one minor child reside in the home. Licensee reminded once a person turns 18 years of age, and if living or working in the home, criminal record clearance is required. Physical plant toured to inspect for health and safety hazards in the licensed areas. Outdoor space inspected for health and safety hazards; outdoor play area is completely fenced. The daycare has a fully charged fire extinguishers, smoke detector, and a carbon monoxide (CO) detector in the home. First aid supplies are available. Detergents, cleaning compounds, medications, and other items which could pose a danger to children is stored inaccessible to children. The daycare area is kept clean and orderly and has adequate heating and ventilation for safety and comfort. Per Licensee, there are no firearms or weapons in the home. There are dogs in the home in the off limits area during daycare hours. No spas, swimming pools, hot tubs, fish ponds, or similar bodies of water are present. Variety of age appropriate toys and materials is observed in the daycare. A sick child would be separated from the group and wait for parent to pick up. Licensee has current Pediatric First Aid and CPR training (exp 7/17/2023). The last emergency disaster drill was conducted on 10/26/2022 and is appropriately logged. Children and staff files reviewed. In the children's files reviewed, all have complete files. In the staff files reviewed, all files are complete. Licensee and helper have the required staff immunizations: measels (MMR) and pertussis (Tdap). Licensee has verification of the mandated child abuse training compliant with AB1207. All the required licensing forms are posted in a prominent accessible location: License, Personal Rights, and Emergency Disaster Plan.

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SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Andrea MedlinTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 12/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/22/2022
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: CALVIO, LIGIA R.
FACILITY NUMBER: 414001633
VISIT DATE: 12/22/2022
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LPA 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.

Incidental Medical Services (IMS) policy discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA is 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. Facility informed that effective September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.

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.

This report is reviewed with facility representative and a copy of this report must be made available for public review upon request. Notice of Site Visit posted and shall remain posted for 30 days.

SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Andrea MedlinTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022
LIC809 (FAS) - (06/04)
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