414002550-11-13-2019-05-CC-ACON-BH2Q6C-20191017115317

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414002550
Report Date: 10/17/2019
Date Signed: 11/13/2019 12:49:21 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:	NAVARRO, ANA		FACILITY NUMBER:	414002550
ADMINISTRATOR:	NAVARRO, ANA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 394-4150
CITY:	SAN CARLOS	STATE: CA	ZIP CODE:	94070
CAPACITY:	14	CENSUS: 13	DATE:	10/17/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Ana Navarro		TIME COMPLETED:	12:15 PM

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	* This is an amended report for 10/17/19 annual inspection.* On 10/17/19 at 8:45, Licensing Program Analyst (LPA) April Cowan, met with Licensee’s helper Eunice Lopez. Licensee, Ana Navarro, was not present at the time of entry, but did return to the facility approximately 9:00 am. Purpose of the inspection was explained and was for Annual/Random inspection. Present in the facility is Licensee’s two helpers caring for thirteen children (11 preschoolers and 2 infants). Licensee owns home, which is a one story home with three bedrooms and two bathrooms. Day Care areas are: Rear sun room, rear bedroom, bathroom #2, and back yard. The off- limit areas are: The rest of the home. Licensee lives with husband, one adult child, and one minor child. 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 working smoke and carbon monoxide detector, and a fully charged fire extinguisher. There are no bodies of water in the Home. Licensee states there are no guns or weapons of any kind in the home. Licensee’s CPR expires in 05/18/21. Licensee conducted last emergency drill on 8/14/19 and is properly logged. Licensee provides daily snacks and meals. Discipline policy is mainly redirection. All required postings are properly posted. Licensee has required proof of immunization and Mandated Reporter Training certificate on file.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) -26-8800
LICENSING EVALUATOR NAME: April Cowan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 11/07/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2019

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: NAVARRO, ANA	FACILITY NUMBER: 414002550
	VISIT DATE: 10/17/2019

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
26
27
28
29
30
31
32

At 8:50 am, LPA observed 1 preschooler restrained in feeding chair. LPA inquired the reason for restraint and Helper, Eunice stated that child had been eating. At 8: 57, LPA observed 3 different preschoolers restrained in eating chairs during singing class singing activity. This is a Type A violation. LPA, once again, instructed helper to remove children from restraints. At this time, LPA also observed that the cabinet where cleaning products were stored was unlocked and accessible to the children. This is a Type A violation and dangerous for children in care.
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.
Closing Statement
An exit interview was conducted and plans of Correction were reviewed and developed with the Licensee. A copy of this report and appeal rights were discussed and left with licensee, Ana Navarro, whose signature on this form confirms receipt of these documents.

>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

> See attached page for deficiency cited today.

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) -26-8800
LICENSING EVALUATOR NAME: April Cowan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2019

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: NAVARRO, ANA	FACILITY NUMBER: 414002550
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/17/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/25/2019 Section Cited	1 2 3 4 5 6 7	*This is an amended report for 10/17/19 annual inspection* 102423 (a) (2) Personal Rights (a) Each child receiving services from a family child care home..... (2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment. This requirement was not met as evidenced by:
	8 9 10 11 12 13 14	Based on observation licensee did not comply with regulation. During the visit, LPA observed 4 different children in feeding chairs not during feeding time. This poses a potential health and safety risk for children in care.	8 9 10 11 12 13 14
Type B 10/25/2019 Section Cited	1 2 3 4 5 6 7	102417 (g)(4) Operation of a Family Child Care Home The home shall be free from defects or conditions which might endanger a child...(4) Poisons, detergents, cleaning compounds,... shall be stored where they are inaccessible to children. This requirement was not met as evidenced by:
	8 9 10 11 12 13 14	Based on observation, licensee did not comply with regulation. Licensee did not lock cabinet with cleansers that was accessible to children. This poses potential risk for children in care.	8 9 10 11 12 13 14

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: Garfield Leung	TELEPHONE: (650) -26-8800
LICENSING EVALUATOR NAME: April Cowan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2019

LIC809 (FAS) - (06/04)

Page: 3 of 3