414002826-1-26-2022-05-CC-AMEN-CB32SY-20220126163956

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414002826
Report Date: 01/26/2022
Date Signed: 01/26/2022 04:40:00 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:	CRUZ, CHRISTIE T.		FACILITY NUMBER:	414002826
ADMINISTRATOR:	CRUZ, CHRISTIE T.		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 278-6163
CITY:	SOUTH SAN FRANCISCO	STATE: CA	ZIP CODE:	94080
CAPACITY:	14	CENSUS: 4	DATE:	01/26/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Christie Cruz		TIME COMPLETED:	04:45 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) Andrea Medlin met with Licensee for this required annual licensing visit today. Purpose of visit explained. Days and hours of operation: Monday-Friday 7:00AM-6:00PM. There are 4 children in care today; 2 infants and 2 preschool aged. Per Licensee, she, husband, and one minor child reside in the home. Criminal record clearance is on file for all adults in the home. Physical plant toured to inspect for health and safety hazards in the licensed areas. Outdoor space inspected for health and safety hazards; outdoor play area is completely fenced. The daycare has a fully charged fire extinguisher that meets the minimum requirements, smoke detector, and a carbon monoxide (CO) detector. Detergents, cleaning compounds, medications, and other items which could pose a danger to children is stored inaccessible to children. The daycare area has adequate heating and ventilation for safety and comfort. Per Licensee, there are no pets or firearms or weapons in the home. No spas, swimming pools, or hot tubs are present, however this is a covered and gated fish pond in the outdoor area. Variety of age appropriate toys and materials is observed in the daycare. A sick child would be separated from the group and wait for parent to pick up. Licensee has expired Pediatric First Aid and CPR training (exp. 2/2021) and will is in process of renewing. Mandated Child Abuse Reporter Training (AB1207) needs to be renewed (exp 3/3/2021). Children's files reviewed. LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. Incidental Medical Services (IMS) policy discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm. (Continued on next page 809-C)

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Andrea Medlin	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2022

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: CRUZ, CHRISTIE T.	FACILITY NUMBER: 414002826
	VISIT DATE: 01/26/2022

NARRATIVE

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To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

This report is reviewed with facility representative and a copy of this report must be made available for public review upon request.

Notice of Site Visit posted and shall remain posted for 30 days.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Andrea Medlin	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2022

LIC809 (FAS) - (06/04)

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