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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004155
Report Date: 10/18/2022
Date Signed: 10/18/2022 11:47:28 AM


Document Has Been Signed on 10/18/2022 11:47 AM - 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, DINAFACILITY NUMBER:
414004155
ADMINISTRATOR:BOBEICA, DINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(347) 681-1423
CITY:SAN MATEOSTATE: CAZIP CODE:
94403
CAPACITY:14CENSUS: 11DATE:
10/18/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Dina BobeicaTIME COMPLETED:
12:05 PM
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On October 18, 2022 at approximately 11:05am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, plan of correction (POC) visit. LPA met with licensee, Dina Bobeica, and explained the purpose of the visit. Present during LPA's visit included licensee, licensee's two assistants (A1 and A2) and 11 enrolled children (all preschool age).

On October 6, 2022 at approximately 12:35pm, LPA Quimbo met with licensee to conduct an unannounced, annual inspection at facility. During annual inspection, LPA observed an individual directly working with the children, to not have fingerprint clearance on file. LPA issued licensee a Type A citation for an uncleared adult directly working with and supervising enrolled children. A POC was developed with licensee.

As of this date, licensee stated uncleared adult no longer works at facility. Licensee has hired a new assistant, A2, that has began working at facility as of 10/17/2022. LPA observed A2 to have fingerprint clearance on file. A2 also has a completed Mandated Reporter training certificate that will expire 10/2024 and a CPR certificate that will expire 10/2024. LPA reminded licensee A2 must provide proof of required immunizations to make available for review. Licensee stated she understood.

During today's visit, LPA observed signed and completed Acknowledgement of Receipt of Licensing Reports (LIC9224) for enrolled children. LPA observed Notice of Site Visit issued on 10/06/2022 to be properly posted in the home, available for review.

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.

Deficiency cited on October 6, 2022 has been cleared. LPA provided licensee copy of POC letter. No deficiencies were cited today.

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.

Exit interview conducted and report was reviewed with licensee, Dina Bobeica.
SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina QuimboTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 10/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/18/2022
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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