414004066-12-10-2019-05-CC-MROZ-BJR2E7-20191210161927

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004066
Report Date: 12/10/2019
Date Signed: 12/10/2019 04:19:35 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:	DURHAN, ROSSANA & KEVIN		FACILITY NUMBER:	414004066
ADMINISTRATOR:	ROSSANA DURHAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 348-5009
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94401
CAPACITY:	14	CENSUS: 4	DATE:	12/10/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:52 PM
MET WITH:	Rossana Durhan		TIME COMPLETED:	04:35 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) Marie Rodriguez conducted an unannounced Annual Random inspection. LPA met with Licensee Rossana Durhan and explained purpose of inspection. Home is a single story house with three bedrooms and two bathrooms. Licensee lives in the home with her adult son. Present in home were the Licensee, a helper, and 4 infant children. Licensee is operating within capacity requirements on this day. All adults living or working in the home have a criminal record clearance on file. Hours of operation are Monday to Friday from 7:00am to 5:00pm. Day Care Areas: Living room, dining room, bedroom #1 (napping only), bedroom #2, bathroom #1, and backyard. Off Limit Areas: Kitchen, bedroom #3, office, bathroom #2, garage, and side yard. LPA toured day care areas of home with Licensee. LPA observed home to be clean and in good repair with proper temperature and ventilation. Per Licensee, there are no weapons or firearms in the home. There are no bodies of water on the premises. Fireplace is properly barricaded. There is a variety of age appropriate toys and equipment in the home and outside in the outdoor play area of the backyard which are in good condition. Outdoor play area is fenced for supervision. Napping equipment is in good condition and properly stored when not in use. All cleaning supplies, poisons, and other chemicals are stored inaccessible to children. There is a working smoke detector and carbon monoxide detector, a fully charged fire extinguisher, and a working telephone. Phone number listed for license is current. Four children records reviewed were complete. All children have a record of emergency identification information on file. Licensees' records were reviewed and complete. Licensees' and helpers' Pediatric First Aid/CPR certificate expires August 2020. Licensees and helpers have current Mandated Reporter training. Last emergency drill was conducted on August 16, 2019. Emergency drills are conducted every six months and are properly logged. (Continued on second page)

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2019

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: DURHAN, ROSSANA & KEVIN	FACILITY NUMBER: 414004066
	VISIT DATE: 12/10/2019

NARRATIVE

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Incidental Medical Services (IMS) was discussed. Licensee has one child who need services at this time. LPA reviewed the child's record for the doctor's note and parents' authorization to administer. Medication is inaccessible to children in care. 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 Americans with Disabilities Act (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: www.ada.gov/childqanda.htm.

During inspection,

Licensee was given information regarding Safe Sleep Practices, Technical Support Program, and Lead Poisoning Facts.
Licensee was reminded, as of September 1, 2016, all Staff and Volunteers must provide proof of immunization against pertussis, measles, and influenza, or qualifies for an exemption, pursuant to Health and Safety code 1596.7995 and 1597.622.
Licensee was reminded about Mandated Reporter training available on CCLD website. Training must be completed every 2 years. Training can be taken online at www.mandatedreporterca.com
Licensee was reminded about the Provider Information Notices (PINs) on CCLD website.
Licensee was advised for any additional questions to contact CCLD office, Monday to Friday, 8:00 am - 5:00 pm, (650) 266-8800 or 1 (844) 538-8766. Website: www.cdss.ca.gov.

No deficiencies cited today.

This report was reviewed and discussed with Licensee Rossana Durhan. A copy of report was provided.
Notice of site visit was observed being posted and shall remain posted for 30 days.

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2019

LIC809 (FAS) - (06/04)

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