<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002550
Report Date: 11/13/2019
Date Signed: 11/13/2019 01:45:54 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:NAVARRO, ANAFACILITY NUMBER:
414002550
ADMINISTRATOR:NAVARRO, ANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 394-4150
CITY:SAN CARLOSSTATE: CAZIP CODE:
94070
CAPACITY:14CENSUS: 11DATE:
11/13/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Ana NavarroTIME COMPLETED:
02:00 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
On 11/13/19 at 9:30 am, Licensing Program Analysts (LPAs) April Cowan and Cindy Interiano conducted a case management inspection and met with licensee, Ana Navarro. The purpose of the inspection was explained and LPAs were granted access by licensee. The home was inspected for health and safety hazards. Day care areas are play room, nap room, bathroom 1, and backyard. Off-limit areas are bedroom 1, living room, kitchen, dining area, bedroom 2 and bathroom 2, bathroom 3. Licensee has requested to use bedroom 3 for napping . Bedroom 3 is now an approved day care area.

During inspection LPAs observed 3 children sitting in feeding chairs during activities. This is a repeat violation and civil penalties were issued. Licensee states she understands children are not allowed to be placed in the feeding chairs unless they are eating. During other activities, Licensee is able to use the chairs, however children should not be buckled in or have the table placed, preventing children from moving around freely.
Also during the inspection, LPAs observed 2 baby rockers/chairs in the nap room. Licensee states she does not use them, however LPAs advised Licensee that baby rockers/chairs are not permitted in licensed Family Child Care Homes and must be maintain in off limit area during daycare hours.

>See page 2 for deficiencies issued today under Title 22 Division 12 of the Ca. Code of Regulations.

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

DATE: 11/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2019
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 2
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: 11/13/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/13/2019
Section Cited

1
2
3
4
5
6
7
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 3 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
however during other activities, children should not be buckled in or have the table placed, preventing children from moving around freely.

A return inspection will be made.
Type B
11/13/2019
Section Cited

1
2
3
4
5
6
7
102417 (g)(10) Operation of a Family Child Care Home. A baby walker or similar items are not permitted on the premises of a family child care home in accordance with Health and Safety Code Sections 1596.846(b)&(c).
8
9
10
11
12
13
14
This requirement was not met as evidence based on LPAs' observation of two baby rockers/bouncers in the daycare area.
This poses a potential health and safety risk to children in care.
8
9
10
11
12
13
14
A return inspection will be made.
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 LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April CowanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 11/13/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/13/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2