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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002282
Report Date: 03/11/2020
Date Signed: 03/11/2020 03:47:26 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:PASALLO, ISABELFACILITY NUMBER:
414002282
ADMINISTRATOR:PASALLO, ISABELFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 494-4169
CITY:MENLO PARKSTATE: CAZIP CODE:
94025
CAPACITY:14CENSUS: 6DATE:
03/11/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Licensee, Isabel PasalloTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA), Cindy Interiano, met with Licensee, Isabel Pasallo for a 1 year Annual inspection. Purpose of the inspection was explained. LPA arrived at 2:00p and observed Licensee and Husband caring for 6 children (1 infant and 5 PreK). Licensee is within capacity limits of a large capacity license. Licensee owns home, which is a 3 bedroom, 1 Full Bathroom, 2 Half Bathrooms, and an In-Law unit in the backyard with a full Bathroom. Licensee lives with Husband, Adult Daughter and minor grandson. All adults have criminal record clearance. Licensee advised LPA that In-Law unit has been renovated and requested inspection to use In-Law unit for Daycare use. LPA inspected In-Law unit for Health and Safety hazards. In-law unit/Daycare room has a full bathroom, and kitchenette.
Daycare areas are: Backyard, Entire In-law Unit with Bathroom. OFF limit area: Entire Main house: Living Room, Dining Room, Family Room, Garage, Bathroom #1, Half bathrooms #1 and #2, Bedroom #1, #2, and #3. All off limit areas, including closets, are 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. Licensee has provided an updated telephone and email address. Chimney is in the main house, which is off limits. 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 and Husband’s CPR expires in 09/2021. Licensee conducted last fire drill on 03/02/20 and is properly logged. Licensee offers daily snacks and meals. Discipline policy is redirection. All required postings are properly posted. Licensee and Husband has required proof of immunization on file. Children’s files and roster were reviewed at 03:10p and are complete and up-to-date.

LPA requested Licensee to send LPA an updated LIC 999 (Facility Sketch) and LIC 610 (Emergency Disaster Plan). LPA advised Licensee that a request will be sent to Fire Inspector for a fire clearance of the In-law unit.

See Page 2. . .
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2020
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: PASALLO, ISABEL
FACILITY NUMBER: 414002282
VISIT DATE: 03/11/2020
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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 Husband will wait for Training to be 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: 03/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2020
LIC809 (FAS) - (06/04)
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