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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004158
Report Date: 11/07/2019
Date Signed: 11/07/2019 05:01:55 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:ESPINOZA, VICTORIAFACILITY NUMBER:
414004158
ADMINISTRATOR:ESPINOZA, VICTORIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 520-9802
CITY:SAN MATEOSTATE: CAZIP CODE:
94401
CAPACITY:14CENSUS: 11DATE:
11/07/2019
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Victoria EspinozaTIME COMPLETED:
05:15 PM
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Licensing Program Analyst (LPA) Marie Rodriguez made an unannounced Annual Continuation inspection. LPA met with staff and explained purpose of inspection. Licensee Victoria Espinoza was notified by phone and arrived a short time later. Present in home were the Licensee, her husband, two helpers, and 11 children (3 infants and 8 preschool age). Licensee is operating within capacity requirements on this day. Hours of operation are Monday to Friday from 7:00 am to 6:00 pm.

Eleven children records reviewed were complete. All children have a record of emergency identification information on file. Licensee's Pediatric First Aid/CPR certificate expires February 2020. Four staff records reviewed were complete. All adults living or working in the home have a criminal record clearance on file. Last emergency drill was conducted in July 2019. Emergency drills are conducted every three months and are properly logged. Incidental Medical Services (IMS) was discussed. Licensee has no children who need services at this time.

During inspection,
  • Licensee was given information regarding Safe Sleep Practices.
  • Licensee was advised 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, 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 1597.662.
  • Licensee was provided information regarding Americans with Disabilities Act (ADA): 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.
  • 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 Victoria Espinoza. 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 MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2019
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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