414002295-2-23-2022-05-CC-HRCO-CBWVMK-20220223153336

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414002295
Report Date: 02/23/2022
Date Signed: 02/23/2022 03:34:49 PM

Document Has Been Signed on 02/23/2022 03:34 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	DE OCAMPO, ANA		FACILITY NUMBER:	414002295
ADMINISTRATOR:	DE OCAMPO, ANA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 422-9444
CITY:	MENLO PARK	STATE: CA	ZIP CODE:	94025
CAPACITY:	12	CENSUS: 6	DATE:	02/23/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Ana De Ocampo		TIME COMPLETED:	10:50 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	Licensing Program Analyst (LPA) Haydee Caliboso arrived at the facility at 9:15am to conduct an unannounced annual inspection. LPA met with Licensee Ana De Ocampo. Purpose of the inspection was explained. Present during the inspection were Licensee, 5 preschool-age children, and 1 school-age child, and Licensee’s 13 years old son. Provider is operating within the capacity and is following staff child ratio. The Licensee lives with 2 children, and Licensee’s husband. Licensee’s husband fingerprint clearance is currently pending. The hours of operation are: M-F, 8:00 AM – 6:00 PM. Licensee provides breakfast, snack, and lunch each day. The facility was inspected today, indoors and outdoors for health and safety hazards. Daycare areas: Kitchen, living room area, bathroom, and outdoor area. LPA instructed the Licensee to send updated LIC 999A and label off limit and day care areas. Off Limit areas: all bedrooms in the home. LPA and Licensee inspected the entire day care area for health and safety hazards. LPA observed that off limit areas were properly locked and made inaccessible to the children in care. LPA observed the fireplace has been barricaded and made inaccessible to children. LPA observed carbon monoxide and smoke detector in the home. A fire extinguisher of size 2A10BC or bigger was also available in the home. First Aid kit is fully stocked and accessible. Per Licensee, there is no firearm or weapon in the home. Licensee stated there are no bodies of water. Per Licensee, there are no children in care who needs medications while in care. LPA observed that the house is in good repair, and free of hazards with proper temperature and ventilation. LPA observed that there is a variety of age appropriate toys, books and other learning material available in the home for the children in care. Cont. 809-C pg. 2

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650)266-8864
LICENSING EVALUATOR NAME: Haydee R Caliboso	TELEPHONE: (650)266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2022

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: DE OCAMPO, ANA	FACILITY NUMBER: 414002295
	VISIT DATE: 02/23/2022

NARRATIVE

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Electric outlets have been secured, and a working phone is on site. Per Licensee, discipline policy is redirection or communicate about positive behavior practices.

All posting requirements are met and posted near the day care entrance. Licensee has First Aid CPR that expires 02/2024. LPA observed that files have records of immunization, names, addresses and telephone numbers of each child's authorized representative. Licensee and staff have mandated report in file. Emergency drills are conducted at least once every six months and properly logged. The last emergency drill was conducted on 02/2022. All required posting documents are posted and visible. LPA instructed the Licensee that Licensee’s husband needs to get re-fingerprinted and all adults living in the home needs to have a copy of TB clearance, LIC 9108, and LIC 508 kept in file.

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.
Cont. 809-C pg.3

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650)266-8864
LICENSING EVALUATOR NAME: Haydee R Caliboso	TELEPHONE: (650)266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2022

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: DE OCAMPO, ANA	FACILITY NUMBER: 414002295
	VISIT DATE: 02/23/2022

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The Licensee was reminded about Mandated Reporter training available on the CCLD website. In addition to the AB1207 a total of 7 hrs training must be completed every two years by all staff hired, a one-time General Training is also required. Training can be taken online at www.mandaterreporterca.com.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm

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.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with Ana De Ocampo. Today’s report and notice of site visit will be sent to the Licensee by the end of the day on 02/23/22. Confirmation of receipt is required.

>No deficiencies were cited today under Title 22 Division 12 of the California Code of Regulations.

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650)266-8864
LICENSING EVALUATOR NAME: Haydee R Caliboso	TELEPHONE: (650)266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2022

LIC809 (FAS) - (06/04)

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