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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002283
Report Date: 10/18/2019
Date Signed: 10/18/2019 01:14:06 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:SANDOVAL, BEATRIZ E.FACILITY NUMBER:
414002283
ADMINISTRATOR:SANDOVAL, BEATRIZ E.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 679-8021
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94061
CAPACITY:14CENSUS: 4DATE:
10/18/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Beatriz E. SandovalTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Singh met with licensee, Beatriz Sandoval, for an annual random inspection. The purpose of the inspection was explained. Licensee lives in a single family home. Present, there are four children (One infant, three pre school age) in care with licensee and one helper. All adults living or working in the home have criminal background check on file. Licensee is operating within the capacity of this date. Licensee provides day care from Monday to Friday between 8 AM to 5:30 PM.

LPA inspected the day care areas with the licensee. Day Care Areas: On ground floor - Living Room, Dining area, Bathroom and Backyard. Off limit areas: Garage, Kitchen and entire second floor. There is no pool, spa or any other body of water in the house. As per licensee, there is no firearm or weapon in the house. Stairs has child protective gates installed to keep them inaccessible for children. All the cleaning supplies, poisons and other chemicals are stored inaccessible to the children. Cabinets in bathroom and kitchen have child protective locks in place. The house is in good repair and free of hazards with proper temperature and ventilation. There is carbon monoxide detector, smoke detector, fully charged fire extinguisher and working telephone available in the house. There is a variety of age appropriate toys in the house.

At 12:10 PM, LPA review the records. Licensee has all of the required documents posted and are visible for the public. LPA reviewed the identification and emergency information form for every child for proper names and numbers filled. Licensee has immunization record of all of the children in care. Licensee has record of training of preventive health and CPR card valid until September 2021. Licensee has completed the Mandated reporter training in December 2017. The training can be renewed online at www.mandatedreporterca.com.

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SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Gagandeep SinghTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2019
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: SANDOVAL, BEATRIZ E.
FACILITY NUMBER: 414002283
VISIT DATE: 10/18/2019
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LPA discussed the safe sleep regulation concepts and a handout was provided. LPA encourage the licensee to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. LPA discussed the effects of lead exposure and provided a handout.

No deficiencies are cited today. The copy of this report is reviewed and provided to the licensee. Notice of site visit is posted and shall remain posted for next 30 days.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Gagandeep SinghTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2019
LIC809 (FAS) - (06/04)
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