414002948-1-17-2020-05-CC-CINO-BKWQZD-20200117113632

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414002948
Report Date: 01/16/2020
Date Signed: 01/17/2020 11:36:35 AM

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:	VASA, LUDMILA		FACILITY NUMBER:	414002948
ADMINISTRATOR:	VASA, LUDMILA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 553-0259
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94403
CAPACITY:	14	CENSUS: 10	DATE:	01/16/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Licensee’s Husband, Joel Vasa		TIME COMPLETED:	03:45 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), Cindy Interiano, met with Licensee’s Husband, Joel Vasa. Licensee was at an appointment. Purpose of the inspection was explained and was for an Annual/Random inspection. Present was Licensee’s Husband and Helper caring for 10 children (2 infants and 8 PreK). Home is a 3 Bedroom, 1.5 Bathroom, single level house. Licensee lives with Husband and 3 minor children. Licensee has a pet dog, who is current in their immunization, pet birds, and a chicken coop in the backyard. All adults have criminal record clearance. Facility was inspected and Daycare areas are: Living Room, Dining area, Kitchen, Bedroom #1, Bedroom #2, Bathroom #1, and Backyard. Off limit areas are: Master Bedroom #3 with Bathroom #0.5, Garage, and Front yard. All off limit areas, including closets and chicken coop in the backyard, 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. Chimney in the Living room is properly barricaded. Wall heaters in the Living room area and Hallway are properly barricaded. Home has no bodies of water. There are no poisons, detergents, or cleaning products accessible to daycare children. Licensee's Husband states there are no guns/weapons in the home. Licensee’s and Helper’s CPR expires at the end of 01/2020. Licensee is scheduled to attend a renewal CPR training on 02/02/20. Licensee conducted last emergency drill on 11/18/19 and is properly logged. Licensee provides daily snacks and meals. Discipline policy is mainly redirection. All required postings are properly posted. Licensee and Helpers have required proof of immunization on file, as well as Mandated Reporter training certificates. Children’s files were reviewed and are 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: 01/16/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2020

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: VASA, LUDMILA	FACILITY NUMBER: 414002948
	VISIT DATE: 01/16/2020

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Page 2. . .

During inspection, LPA advised Licensee's Husband to advise Licensee regarding:
*Incidental Medical Services (IMS) policy was discussed.
*Having all Staff and Volunteers provide proof of immunization against influenza, pertussis, and measles or qualifies for an exemption.
*Provider Information Notices (PINs) on CCLD website.
*Mandated Reporter Training available on CCLD website
(www.ccld.ca.gov or www.mandatedreporterca.com).
*The new Lead Bill (effective 01/01/19), requiring Facilities to distribute a two-page flyer to Guardians with information on lead poisoning facts.
*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's Husband. This report must be available in the facility for public review. Notice of site visit was observed being posted.
Licensee's Husband 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: 01/16/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2020

LIC809 (FAS) - (06/04)

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