414002373-10-11-2019-05-CC-FBRR-BGUP4C-20191011105854

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414002373
Report Date: 10/11/2019
Date Signed: 10/11/2019 10:59:02 AM

COMPREHENSIVE INSPECTION

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:	CHAVEZ-CRUZ, DELMA & MEDINA, MARCELA		FACILITY NUMBER:	414002373
ADMINISTRATOR:	D. CHAVEZ-CRUZ & M. MEDINA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 685-6645
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94401
CAPACITY:	14	CENSUS: 7	DATE:	10/11/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Marcela Medina		TIME COMPLETED:	11:15 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) Faye Bremer conducted an unannounced Annual inspection. LPA met with Marcela Medina and explained purpose of inspection. LPA observed 7 children present upon LPA's arrival, with 2 other staff present, who have criminal record clearances and are associated to the home. Day care hours of operations are: Monday – Friday 7:00 AM-5:30 PM. LPA inspected the daycare areas of the home for health and safety hazards. Per Licensee daycare areas are: Living room, dining room, kitchen, and backyard. Off-limit areas: all bedrooms, and garage. LPA observed the following: Home is clean, with sufficient lighting, well ventilated, and at a comfortable temperature. Home has a working smoke and carbon monoxide detector, and a fully charged fire extinguisher. Licensee has two dogs, which are kept separated from children during operating hours. All poisons and hazardous materials are locked, inaccessible and kept out of the reach of children. Per Licensee there are no guns or weapons in the home. Outdoor play area is free from defects or dangerous conditions and fenced for supervision. Home does not have any bodies of water. Fireplace in the living room has a lock and covered by posters. Wall heater is barricaded. Toys and equipment are safe, clean, and age appropriate. Nap equipment are stored in the living room, and labeled for each child. All required postings are posted in the living room. Per Licensee, discipline policy is positive guidance and redirection. Licensee provides meals to the children, which consists of breakfast, lunch, AM snack, and PM snack, and dinner for some children. First Aid Kit is fully stocked and accessible. Emergency drills are conducted and logged, last conducted on 09/13/19. Licensee CPR/First aid expires in 03/2020. Mandated Reporter training completed on 12/23/2018. Continues on the following page, LIC809C.

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Faye Bremer	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2019

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: CHAVEZ-CRUZ, DELMA & MEDINA, MARCELA	FACILITY NUMBER: 414002373
	VISIT DATE: 10/11/2019

NARRATIVE

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Continued from previous page, LIC809.

LPA reviewed with Licensee Safe Sleep Practices for the prevention of SIDS. Licensee was informed about the Provider Information Notices (PINs) on CCLD website, and advised to sign up for email updates if not already receiving them.

Children's files were inspected, and all files contain all required forms, assessments, and agreements.

No Deficiencies cited during today's inspection.
Report reviewed and provided to Marcela Medina

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Faye Bremer	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2019

LIC809 (FAS) - (06/04)

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