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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002410
Report Date: 12/05/2019
Date Signed: 12/05/2019 04:16:15 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:TAPIA, ROSALBAFACILITY NUMBER:
414002410
ADMINISTRATOR:TAPIA, ROSALBAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 340-8630
CITY:BURLINGAMESTATE: CAZIP CODE:
94010
CAPACITY:14CENSUS: 9DATE:
12/05/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Rosalba TapiaTIME COMPLETED:
04:35 PM
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Licensing Program Analyst (LPA) Marie Rodriguez conducted an unannounced Annual Random inspection. LPA met with Licensee Rosalba Tapia and explained purpose of inspection. Present in home were the Licensee, Licensee's husband, a helper, and 9 children (3 infants and 6 preschool age). Licensee is operating within capacity requirements on this day. All adults living or working in the home have a criminal record clearance on file. Hours of operation are Monday to Friday 7:30am to 5:30pm.

Day Care Areas: Garage (converted as a day care room), kitchen, backyard, bedroom #2, hallway room, and bathroom #2. Off Limit Areas: Dining room, living room, bedroom #1, bathroom #1, and porch. LPA inspected day care areas of home with Licensee. LPA observed home to be clean and in good repair with proper temperature and ventilation. Per Licensee, there are no weapons, firearms, or bodies of water in the home. There is a variety of age appropriate toys and equipment in the home and outside in the backyard which are in good condition. Outdoor play area is fenced for supervision. Napping equipment is in good condition and properly stored. All cleaning supplies, poisons, and other chemicals are stored inaccessible to children. There is a working smoke detector and carbon monoxide detector, a fully charged fire extinguisher, and a working telephone. Phone number listed is current.

Four children records reviewed were complete. All children have a record of emergency identification information on file. Licensee and helper records were reviewed and complete. Licensee's Pediatric First Aid/CPR certificate expires January 2021. Helper's Pediatric First Aid/CPR certificate expires March 2021. Last emergency drill was conducted in September 2019. Emergency drills are conducted every four months and are properly logged.

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SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) -26-8800
LICENSING EVALUATOR NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2019
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: TAPIA, ROSALBA
FACILITY NUMBER: 414002410
VISIT DATE: 12/05/2019
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During inspection,
  • Licensee was given information regarding Safe Sleep Practices, Effects of Lead Exposure, and Technical Support Program (TSP).
  • Licensee was reminded, as of September 1, 2016, all Staff and Volunteers must provide proof of immunization against pertussis, measles, and influenza, or qualifies for an exemption, pursuant to Health and Safety code 1596.7995 and 1597.662.
  • Licensee was reminded about Mandated Reporter training available on CCLD website. Training must be completed every 2 years. Training can be taken online at www.mandatedreporterca.com
  • Licensee was reminded about the Provider Information Notices (PINs) on CCLD website.
  • Licensee was advised for any additional questions to contact CCLD office, Monday to Friday, 8:00 am - 5:00 pm, (650) 266-8800 or 1 (844) 538-8766. Website: www.cdss.ca.gov.

No deficiencies cited today.

This report was reviewed and discussed with Licensee Rosalba Tapia. A copy of report was provided.
Notice of site visit was observed being posted and shall remain posted for 30 days.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2019
LIC809 (FAS) - (06/04)
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