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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004158
Report Date: 09/11/2019
Date Signed: 09/11/2019 11:15:56 AM

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: 9DATE:
09/11/2019
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Yuritzi GonzalezTIME COMPLETED:
11:30 AM
NARRATIVE
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Licensing Program Analyst (LPA) Marie Rodriguez conducted an unannounced Annual Required inspection. LPA met with Staff in Charge Yuritzi Gonzalez and explained purpose of inspection. Licensee Victoria Espinoza was notified by phone of inspection but was unable to return to home due to a family emergency. Present in home were Staff in Charge, 1 assistant, and 9 children (3 infants and 6 toddlers). Home is operating within ratio and capacity requirements on this day. All adults working in the home have a criminal record clearance. Hours of operation are Monday to Friday from 7:00am to 6:00pm.

Day Care Areas: Living Room, kitchen, dining area, toddler nap room, infant nap room, bathroom, deck, and backyard. Off Limit Areas: Bedroom, garage, porch, and loft above garage. LPA inspected day care areas of home with Staff in Charge. LPA observed the home to be clean and in good repair with proper temperature and ventilation. There are no bodies of water on the property. The fireplace is properly barricaded. There is a variety of age appropriate toys and equipment in the home. The deck and backyard are clean and have age appropriate toys and outdoor equipment which are in good condition. The deck has a secured gate leading to the backyard. The play structure in the backyard is in good condition and has cushioning underneath. All cleaning supplies, poisons, and other chemicals are stored inaccessible to children. There is a working smoke and carbon monoxide detector, a fully charged fire extinguisher, and a working telephone available.

LPA observed there was no PUB 394 posted in a public area for parents or guardians to easily review. LPA was unable to review children and staff records due to Staff in Charge not having access to them. Per LPA's phone conversation with Licensee, records are locked in the office and inaccessible to staff.

An Annual Continuation will be conducted on a later date to complete Annual inspection.

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SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) -26-8800
LICENSING EVALUATOR NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3
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: ESPINOZA, VICTORIA
FACILITY NUMBER: 414004158
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/11/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/25/2019
Section Cited

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Admission Procedures and Parental and Authorized Representative's Rights - The licensee shall post PUB 394, Family Child Care Home Notification of Parents’ Rights Poster in a prominent, publicly accessible area in the family child care home at all times children are in care.

This requirement has not been met as evidenced by:
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Based on observation, Licensee failed to ensure PUB 394 was easily accessible to parents and guardians which poses a potential personal rights risk to children in care. LPA observed PUB 394 was not visibly posted on the wall of family child care home.
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POC cleared during inspection.
Type B
09/25/2019
Section Cited

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Personnel Records
All personnel records shall be maintained at the child care home and shall be available to the licensing agency for review.

This requirement has not been met as evidenced by:
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Based on intervews, Licensee failed to ensure personnel records were readily available to Licensing to review which poses a potential health and safety risk to children in care. Staff in Charge was unable to access records due to them being locked in office.
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POC shall be received to CCLD office by POC DUE DATE.
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: Alma MaligTELEPHONE: (650) -26-8800
LICENSING EVALUATOR NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 09/11/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/11/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3
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: ESPINOZA, VICTORIA
FACILITY NUMBER: 414004158
VISIT DATE: 09/11/2019
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Staff in Charge was given information regarding Safe Sleep Practices in both English and Spanish.

Deficiencies cited today under California Code of Regulations, Title 22, Division 12, Chapter 1, which follows on LIC 809D.

This report was reviewed and discussed with Staff in Charge Yuritzi Gonzalez . Appeals Rights given. 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) -26-8800
LICENSING EVALUATOR NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3