414004153-10-17-2019-05-CC-GSIH-BH2VCQ-20191017161931

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004153
Report Date: 10/17/2019
Date Signed: 10/17/2019 04:19:36 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:	ROSALES, ROSALVA		FACILITY NUMBER:	414004153
ADMINISTRATOR:	ROSALES, ROSALVA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 787-5736
CITY:	REDWOOD CITY	STATE: CA	ZIP CODE:	94061
CAPACITY:	14	CENSUS: 11	DATE:	10/17/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Rosalva Rosales		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) Singh met with licensee, Rosalva Rosales, for an annual random inspection. The purpose of the inspection was explained. Licensee lives in a single family home. Present, there are 11 children (four infants, seven pre school age) in care with licensee and two helpers. All adults living or working in the home have criminal background check on file. Licensee is operating within the capacity of this date. Licensee provides day care from Monday to Friday between 8 AM to 5:30 PM. LPA inspected the day care areas with the licensee. Day Care Areas: Living Room, Bathroom, Room # 4, Hallway by Kitchen, Outside deck and Backyard. Off limit areas: Room # 1, Room # 2, Kitchen and Garage. There is no pool, spa or any other body of water in the house. As per licensee, there is no firearm or weapon in the house. All the cleaning supplies, poisons and other chemicals are stored inaccessible to the children. Cabinets in the bathroom has child protective locks. There are no stairs in the house. Fireplace has been barricaded. The house is in good repair and free of hazards with proper temperature and ventilation. There is carbon monoxide detector, smoke detector, fully charged fire extinguisher and working telephone available in the house. There is a variety of age appropriate toys in the house. Licensee has sufficient amount of cribs and sleeping equipment available. Licensee has first aid supplies box and backpack available. At 3 PM, LPA reviewed the records. LPA observed licensee has license and other required documents posted by the main enterance and are visible for public. LPA observed licensee has sign in / out sheet in place and well maintained roster on file. LPA reviewed the identification and emergency information form for every child for proper names and numbers filled. Licensee has record of immunization of each child in care. Licensee has record of training of preventive health and CPR card valid until September 2021. LPA remind the licensee to conduct the fire or emergency drills at least once every six months and drills must be logged. Per licensee, last drill was conducted in January 2018. Licensee’s and helper’s immunization record was checked previously. See next page for continuation .......................

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Gagandeep Singh	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2019

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: ROSALES, ROSALVA	FACILITY NUMBER: 414004153
	VISIT DATE: 10/17/2019

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Continuation from previous page ...................

LPA observed licensee has notation of conducting fire or emergency drill. Per notation, last drill was conducted on July 08, 2019. LPA reminded licensee that all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. Licensee is waiting for the training to be available in Spanish.

LPA discussed safe sleep regulation concept and a handout was provided. LPA encourage the licensee to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. LPA discussed the effects of lead exposure and informed about the brochure to be handed out. LPA provided a copy of the brochure.

No deficiencies are cited today. The copy of this report is reviewed and provided to the licensee. Notice of site visit is posted and shall remain posted for next 30 days.

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Gagandeep Singh	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2019

LIC809 (FAS) - (06/04)

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