414004177-5-14-2019-05-CC-LGOZ-BC6N7G-20190514101243

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004177
Report Date: 05/14/2019
Date Signed: 05/14/2019 10:14:22 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:	GONZALEZ, STELLA MARIE		FACILITY NUMBER:	414004177
ADMINISTRATOR:	GONZALEZ, STELLA MARIE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 235-9240
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94403
CAPACITY:	14	CENSUS: 9	DATE:	05/14/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:20 AM
MET WITH:	Licensee, Stella M. Gonzalez		TIME COMPLETED:	10:25 AM

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), Luis J. Gomez, met with Licensee, Stella M. Gonzalez. Purpose of the inspection was explained and was for an Annual/Random inspection. Present in the facility is Licensee and 2 helpers caring for 9 children. All 9 children in care are in PreK. Licensee is within capacity limits of the License. Licensee home is a 2 bedroom, 1 bathroom, 1- level house. Hours of Operation are: Mon-Fri 8:00-5:30pm. Daycare areas are: Workroom, Dining Area, Bathroom #1, Bedroom #1 and Backyard Area. Licensee stated that she shares the yard area with the neighbors. Off Limit areas are: Kitchen, Bedroom #2 and Laundry room (Pass through only). All off limit areas are properly barricaded with child safe fencing. LPA observed the following: Daycare area is equipped with age appropriate toys and equipment for the children. Home has ample lighting and ventilation. Home has a working telephone, a working smoke and carbon monoxide detector, and a fully charged fire extinguisher. Chimney is properly barricaded and inaccessible to children in care. Licensee stated that there are no pets in the home. There are no bodies of water in the Home. There are no poisons, detergents, cleaning products, or sharp objects accessible to daycare children. Licensee states there are no guns or weapons in the home. Licensee conducted last emergency drill on 1/2019 and is properly logged. Licensee provides daily snacks and meals for children in care. All required postings are properly posted next to the front door. LPA observed hazardous materials in backyard during today’s inspection: LPA observed Worn-down equipment, Broken children’s table, broken bikes and tricycles in the daycare. LPA reviewed facility personnel files. LPA observed licensee’s CPR/ 1^st aid certification has expired. Licensee and helpers have required proof of Mandated Reporter Training certificate on file. Children’s roster and files were reviewed during today’s inspection. LPA observed all children’s files and roster are complete and up to date. See Page 2. . .

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8832
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 393-9134
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2019

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: GONZALEZ, STELLA MARIE	FACILITY NUMBER: 414004177
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/14/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/11/2019 Section Cited CCR 102423(a)(2)	1 2 3 4 5 6 7	102423(a)(2) Personal Rights. Each child shall be accorded safe, healthful and comfortable accommodations, furnishing and equipment.	1 2 3 4 5 6 7	Licensee will make the yard safer for all children in care by throw away toys that are broken and storing equipment not in use by the due date: 6/11/2019 Licensee will submit proof of corrections to licensing.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by LPA observed Worn-down equipment, Broken children’s table, broken bikes and tricycles in the daycare. This presents a potential health and safety hazard to children in care.	8 9 10 11 12 13 14
Type B 06/25/2019 Section Cited CCR 102416(c)	1 2 3 4 5 6 7	102416(c) Personnel Requirements. The licensee and other personnel as specified shall complete training on preventative health practice including pediatric cardiopulmonary resuscitation and pediatric first aide, pursuant to health and safety code section 1596.866	1 2 3 4 5 6 7	Licensee will schedule and complete required CPR/1st aide training by the due date: 6/25/2019. Licensee will submit proof of certification to licensing.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by LPA observed licensee’s CPR/ 1st aid certification has expired. This is a potential health and safety hazard to children in care.	8 9 10 11 12 13 14

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 Malig	TELEPHONE: (650) 266-8832
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 393-9134
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2019

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: GONZALEZ, STELLA MARIE	FACILITY NUMBER: 414004177
	VISIT DATE: 05/14/2019

NARRATIVE

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Page 2. . .

During inspection,
*Incidental Medical Services (IMS) policy was discussed.
*Licensee was reminded about having all Staff and Volunteers provide proof of immunization against influenza, pertussis, and measles or qualifies for an exemption.
*Licensee was reminded about the Provider Information Notices (PINs) on CCLD website.
*Licensee was reminded about Mandated Reporter Training available on CCLD website (www.ccld.ca.gov or www.mandatedreporterca.com)
*Licensee was given information regarding ‘Safe Sleep’ practices.

>See attached deficiencies page for deficiencies issued today under Title 22 Division 12 of the Ca. Code of Regulations.

>This report and rights to comment and appeal were discussed with Licensee. This report must be available in the facility for public review. Notice of site visit was observed being posted.
Licensee was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.cdss.ca.gov

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8832
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 393-9134
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2019

LIC809 (FAS) - (06/04)

Page: 2 of 3