414004099-2-2-2022-05-CC-KMEO-CB9SGF-20220202125151

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004099
Report Date: 02/02/2022
Date Signed: 02/02/2022 12:53:21 PM

Document Has Been Signed on 02/02/2022 12:53 PM - It Cannot Be Edited

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:	ESGUERRA, ANTHONY & SUSPINE, DAY ANNE		FACILITY NUMBER:	414004099
ADMINISTRATOR:	ESGUERRA, A. & SUSPINE, D.		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 235-9420
CITY:	FOSTER CITY	STATE: CA	ZIP CODE:	94404
CAPACITY:	14	CENSUS: 6	DATE:	02/02/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:50 AM
MET WITH:	Licensee, Day Anne		TIME COMPLETED:	01:05 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 Feburary 2, 2022 at 10:45 am, Licensing Program Analyst (LPA) Kassandra Medrano conducted an annual random inspection which included a toured the home and yard, and a review of the required day-care forms with the licensee, Day Anne today. Present in the home was licensee, Day Anne, alone with 3 infants and 3 toddlers. This type of home is a single family home. Off limit rooms were identified as garage, and 2 bedrooms. Adults living in the home are only the two licensees. A review of records indicates that all adults working or living in the home who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Licensee's rent home. The day-care operates 7am-6pm, Monday through Friday. Licensee has parent’s sign the affidavit. LPA observed the following: Day-care area is clean, orderly, and equipped with age appropriate toys and equipment for the children. No baby walkers, bouncers, exercausers, etc. allowed to be used during day-care hours. Home has proper lighting and ventilation. Home has a working telephone, a working smoke and carbon monoxide detector, and a fully charged 2A10BC fire extinguisher. Licensee states there are no bodies of water on the property. There is fireplace in the day-care area, and is properly barricaded. There are no detergents, or cleaning products accessible to day-care children. Poisons are locked. Licensee states there are no guns or weapons of any kind in the home. The yard is fenced. Licensee states there is one dog present in the facility, vaccinations are current, Emergency drills are conducted at least once every six months and properly logged. Licensee provides daily snacks and meals. Isolation of sick children reviewed/discussed. Children’s roster was reviewed and is complete and up-to-date. Children were reviewed. Supervision and transportation of children was discussed. Capacity options were reviewed. Licensee understands that care cannot be provided for more than the capacity as stated on the license as well as requirements when needing an assistant.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Kassandra Medrano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022

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: ESGUERRA, ANTHONY & SUSPINE, DAY ANNE	FACILITY NUMBER: 414004099
	VISIT DATE: 02/02/2022

NARRATIVE

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Requirements for reporting suspected child abuse was discussed, as well as reporting requirements for unusual incidences. Licensee has updated immunization's and Mandated Reporter Training on file.
Licensee was reminded that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.

Licensee was informed 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). Information regarding 'A Child Care Provider's Guide to Safe Sleep' was provided to the Licensee and is available for review on CCLD website.

This report and appeal rights were discussed with Licensee. This report must be available in the facility for public review. Notice of Site Visit was posted. Notice to remain posted for 30 days.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Kassandra Medrano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 02/02/2022 12:53 PM - It Cannot Be Edited

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: ESGUERRA, ANTHONY & SUSPINE, DAY ANNE	FACILITY NUMBER: 414004099
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/02/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(a)

Operation of A Family Child Care Home

(a) The licensee shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise the children during his/her absence. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview with licenseee, the licensee did not comply with the section cited above which posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/02/2022
	Plan of Correction
1 2 3 4	LPA discussed with licensee how to prevent the lack of supervision from happening. Licensee stated she will send a written plan on how to schedule staffing to keep from having supervision issues.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Kassandra Medrano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022

LIC809 (FAS) - (06/04)

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