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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002547
Report Date: 10/03/2019
Date Signed: 10/03/2019 03:16:06 PM

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:COLLUM, CHRISTINA C.FACILITY NUMBER:
414002547
ADMINISTRATOR:COLLUM, CHRISTINA C.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 203-8356
CITY:FOSTER CITYSTATE: CAZIP CODE:
94404
CAPACITY:14CENSUS: 9DATE:
10/03/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Christina CollumTIME COMPLETED:
03:30 PM
NARRATIVE
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Licensing Program Analyst (LPA), Cowan met with Licensee, Christina Collum. The Purpose of the inspection was explained and was for Annual/Random inspection. Present in the facility is Licensee and helper, Liberty Sy, caring for 9 children (04 infants and 5 PreK). Licensee owns home, which is a 4-bedroom, 2.5-bathroom, home and lives with adult son and minor daughter. Facility was inspected. Day care areas: Family room/playroom, living room, half bathroom, kitchen, back yard and front yard. Off limit areas: Dining room and the entire second level. All off limit areas 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 smoke and carbon monoxide detector, and a fully charged fire extinguisher. .Carbon monoxide and smoke detectors were not tested due to children napping. Fireplace in living room is properly barricaded. Stairs are properly barricaded. There are no bodies of water in the home. There are no poisons, detergents, or cleaning products accessible to daycare children. Licensee states there are no guns or weapons of any kind in the home. Licensee’s CPR expires 02/10/21. Licensee provides breakfast, afternoon snacks, and lunch. Discipline policy is mainly redirection. All required postings are properly posted. Licensee has required proof of immunizations. Children’s files were reviewed and are complete and up to date.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) -26-8800
LICENSING EVALUATOR NAME: April CowanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2019
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 3
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: COLLUM, CHRISTINA C.
FACILITY NUMBER: 414002547
VISIT DATE: 10/03/2019
NARRATIVE
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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 was given information regarding ‘Safe Sleep’ practices.

> See attached page for deficiency cited today.

>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) -26-8800
LICENSING EVALUATOR NAME: April CowanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: COLLUM, CHRISTINA C.
FACILITY NUMBER: 414002547
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/03/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/03/2019
Section Cited

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102417 Operation of a Family Child Care Home. (d)The home shall provide safe toys, play equipment and materials. This requirement is not met as evidenced by observation

Based on LPAs observation, licensee has two rock 'n play sleepers in the day care premise, this poses a potential health and safety risk to children in care.


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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) -26-8800
LICENSING EVALUATOR NAME: April CowanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 10/03/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/03/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3