414002694-10-18-2019-05-CC-ACON-BH3UJT-20191018153805

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414002694
Report Date: 10/18/2019
Date Signed: 10/18/2019 03:38:13 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:	VASQUEZ, DEBORAH		FACILITY NUMBER:	414002694
ADMINISTRATOR:	VASQUEZ, DEBORAH		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 544-4852
CITY:	REDWOOD CITY	STATE: CA	ZIP CODE:	94062
CAPACITY:	14	CENSUS: 7	DATE:	10/18/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:35 PM
MET WITH:	Deborah Vasquez		TIME COMPLETED:	03:55 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 10/18/19 at 1:35, Licensing Program Analyst (LPA), April Cowan, met with Licensee, Deborah Vasquez. The purpose of the inspection was explained and was for Annual/Random inspection. Present in the facility is Licensee and helper, Alma Santiago caring for 7 children (4 infants and 3 preschool age). Licensee’s mother Bobby is present. Licensee owns home, which is a 4 - bedrooms, 2.5 - bathroom, single family house. Facility was inspected and Daycare areas are: Living Room, bathroom #1, Backyard, and detached play room. Off Limit areas are: The rest of the home. 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 working smoke and carbon monoxide detector, and a fully charged fire extinguisher. Fireplace in Living room is 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 in 11/04/19. Licensee conducted last emergency drill on 06/07/19 and is properly logged. Licensee provides daily breakfast, lunch, and afternoon snack. Discipline policy is mainly redirection and time out. Licensee states that children are places on time out no longer than 1 minute per year of age. All required postings are properly posted. Licensee has required proof of immunization and Mandated Reporter Training certificate on file. >>> See next page

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) -26-8800
LICENSING EVALUATOR NAME: April Cowan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2019

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: VASQUEZ, DEBORAH	FACILITY NUMBER: 414002694
	VISIT DATE: 10/18/2019

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.

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, , whose signature on this form confirms receipt of these documents.

>No deficiencies were issued today under Title 22 Division 12 of the Ca. Code of Regulations.

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) -26-8800
LICENSING EVALUATOR NAME: April Cowan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2019

LIC809 (FAS) - (06/04)

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