414002755-5-17-2019-05-CC-CINO-BC9UNP-20190517154416

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414002755
Report Date: 05/17/2019
Date Signed: 05/17/2019 03:44:30 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:	TORRES, MARIA LOURDES V.V.		FACILITY NUMBER:	414002755
ADMINISTRATOR:	TORRES, MARIA LOURDES V.V.		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 777-4342
CITY:	MILLBRAE	STATE: CA	ZIP CODE:	94030
CAPACITY:	14	CENSUS: 9	DATE:	05/17/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Licensee, Maria Lourdes		TIME COMPLETED:	04:00 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	Licensing Program Analyst (LPA), Cindy Interiano, met with Licensee, Maria Lourdes Torres. Purpose of the inspection was explained and was for Annual/Random inspection. Present in the facility is Licensee, Husband, and Helper caring for 9 PreK children. Licensee rents home, which is a 4 bedroom, 2 bathroom, single level house. Facility was inspected and Daycare areas are: Classroom/Daycare room, Bathroom #1, Bedroom #3 and #4, and fenced portions of the backyard. Off Limit areas are: Master Bedroom #1 with Bathroom #2, Bedroom #2, Kitchen, Living room, Dining area, Garage, front yard, and portions of the backyard. All off limit areas are properly barricaded. Jacuzzi in the off limits area of the backyard is properly sealed with a lock and surrounded by a fence. 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, an industrial (local) fire alarm, and a fully charged fire extinguisher. Home has a chimney in the Living room, which is an off limit area. 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 02/2020. Licensee conducted last emergency drill on 01/25/19 and is properly logged. Licensee provides daily snacks and children bring their own meals. Discipline policy is mainly redirection. All required postings are properly posted. Licensee and Helpers have required proof of immunization and Mandated Reporter Training certificate on file. Children’s roster was reviewed and is complete and up-to-date. See Page 2. . .

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2019

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 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: TORRES, MARIA LOURDES V.V.	FACILITY NUMBER: 414002755
	VISIT DATE: 05/17/2019

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

Page 2. . .

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.

>No deficiencies were 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: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2019

LIC809 (FAS) - (06/04)

Page: 2 of 2