414004155-10-6-2022-05-CC-CQUO-CJXU2G-20221006151157

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004155
Report Date: 10/06/2022
Date Signed: 10/06/2022 03:12:30 PM

Document Has Been Signed on 10/06/2022 03:12 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:	BOBEICA, DINA		FACILITY NUMBER:	414004155
ADMINISTRATOR:	BOBEICA, DINA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(347) 681-1423
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94403
CAPACITY:	14	CENSUS: 12	DATE:	10/06/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:35 PM
MET WITH:	Dina Bobeica		TIME COMPLETED:	03:30 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 October 6, 2022 at approximately 12:35pm, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, annual inspection. LPA met with licensee, Dina Boeica, and explained the purpose of the inspection. Present during LPA's visit included licensee, 2 assistants (A1 and A2), and 12 enrolled children (all preschool age). Licensee is operating within capacity limits and ratio during LPA's visit. Hours of operation are Monday to Friday from 8:00am to 6:00pm. Licensee lives in a single level, single family home that includes three bedrooms, two bathrooms, two living rooms, kitchen/dining area, garage and backyard. The DAY CARE AREAS are both living rooms, kitchen/dining area, bedroom #2 (napping room only), bathroom and backyard. The OFF LIMIT AREAS are bedroom #1, master bedroom, and garage. With licensee, LPA inspected day care areas for health and safety hazards. LPA observed home to be in good repair with proper temperature and ventilation. Home is equipped with a variety of age appropriate toys and equipment in the home that were in good condition. Cleaning supplies, poisons and other chemicals to be stored inaccessible to children in home's high cabinets and shelves. Home has a carbon monoxide detector, smoke detector, fully charged fire extinguisher and a working phone on site. Phone number listed for licensee is current. Per licensee, there are no weapons or firearms in the home. LPA observed required licensing documents to be properly posted, available for review. Entire backyard is fenced with an at least 5 ft. high fence. LPA did not observe any pools, spas or bodies of water on the property. Backyard is equipped with appropriate outdoor toys and equipment that are in good working condition. (Continue Report on Page 2...)

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2022

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: BOBEICA, DINA	FACILITY NUMBER: 414004155
	VISIT DATE: 10/06/2022

NARRATIVE

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LPA reviewed ten children's records which were complete. Children's files have a record of emergency identification information on file. Licensee's CPR/First Aid certificate is current and will expire 10/18/2022. LPA reminded licensee to renew CPR certification prior to expiration date. Licensee's Mandated Reporter certificate is current and will expire 10/2023.
LPA observed A1's file to have a current CPR certification that will expire 03/2023 and Mandated Reporter training certificate that will expire 11/2023. LPA observed A1 to have fingerprint clearance on file.

LPA observed A2's file to have a current CPR certification that will expire 10/2023 and Mandated Reporter training certificate that will expire 10/2023. LPA did not observe A2 to have fingerprint clearance on file.

Last emergency drill was conducted 04/08/2022. Emergency drills are conducted at least once every six months and are properly logged.

During Inspection:
-Licensee was given information regarding PIN 20-24-CCP Safe Sleep Regulation.
-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 at www.mandatedreporterca.com. Training must be completed every two years by licensee and all staff hired.

Incidental Medical Services (IMS) policy was 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: www.ada.gov/childqanda.htm.

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SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2022

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: BOBEICA, DINA	FACILITY NUMBER: 414004155
	VISIT DATE: 10/06/2022

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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

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

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.

Licensee was cited a Type A citation for uncleared adult directly working with the enrolled children. Please refer to 809D for more information.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Licensee was also provided copy of Appeal Rights and Procedures.

LPA Quimbo informed licensee, Dina Bobeica, that this report dated October 6, 2022 documents one Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Quimbo informed the licensee, Dina Bobeica, to provide a copy of this licensing report dated October 6, 2022 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with the licensee, Dina Bobeica.

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/06/2022 03:12 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: BOBEICA, DINA	FACILITY NUMBER: 414004155
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/06/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

102370(d)(1)

(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, and record review, the licensee did not comply with the section cited above with A2, an uncleared individual, directly working with and supervising enrolled children, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 10/07/2022
	Plan of Correction
1 2 3 4	Licensee will either have A2 go through live scan process to receive fingerprint clearance or licensee will release A2 from work at facility. LPA to conduct follow up inspection.

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: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2022

LIC809 (FAS) - (06/04)

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