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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004252
Report Date: 06/20/2019
Date Signed: 06/20/2019 04:40:25 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:NADELMAN, AMINTAFACILITY NUMBER:
414004252
ADMINISTRATOR:NADELMAN, AMINTAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 452-4228
CITY:PACIFICASTATE: CAZIP CODE:
94044
CAPACITY:14CENSUS: 9DATE:
06/20/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Aminta Nadelman, Fanny NadelmanTIME COMPLETED:
04:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Andrea Medlin met with Licensee, and helper, for this random annual licensing visit. There are 9 children present during the visit; 4 infants and 5 preschool aged. Days and hours of operation: Monday-Friday 7:30AM--6:00PM. Licensee states she, husband, two adult sons, and daughter-in-law reside in the home; criminal record clearance is on file for all adults. Licensee reminded once a person turns 18 years old, and if living or working in the child care, criminal record clearance is required. Physical plant toured to inspect for health and safety hazards. The home has smoke detectors, a fully charged fire extinguisher, and a carbon monoxide (CO) detector. Outdoor space inspected for health and safety hazards; outdoor play area is completely fenced. First aid supplies are available. Detergents, cleaning compounds, medications, and other items which could pose a danger to children are stored inaccessible to children. The daycare area is clean and orderly and has adequate heating and ventilation for safety and comfort. When children are napping on the upstairs level, it is advised a staff person be on the same level. Upstairs area is only used for napping children. Per Licensee, there are no firearms or weapons in the home. No spas, swimming pools, hot tubs, fish ponds, or similar bodies of water are present. Variety of age appropriate toys and materials is observed in the daycare. A sick child would be separated from the group and wait for parent to pick up. Licensee has current Pediatric First Aid and CPR certification (exp 6/2020) and 8 hours health and safety training (completed on 7/2/2016). Licensee has verification of the required mandated child abuse reporting training as compliant with AB 1207; S2 does not have the child abuse training. Licensee has verification of the required immunizations: measels (MMR) and pertussis (Tdap); S2 is missing the measels (MMR) immunization.

(Continued on next pages 809-C and 809-D)
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8867
LICENSING EVALUATOR NAME: Andrea MedlinTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2019
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 4
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: NADELMAN, AMINTA
FACILITY NUMBER: 414004252
VISIT DATE: 06/20/2019
NARRATIVE
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Incidental Medical Services (IMS) policy 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: http://www.ada.gov/childqanda.htm. LPA reviewed with Licensee the Mandated Child Abuse Reporting training as compliant with AB 1207. As of January 1, 2018 all child care staff and volunteers are required to complete Mandated Child Abuse Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

The deficiencies cited on the following page are in violation of the California Code of Regulations, Title 22, Division 12, Chapter 1.

This report is reviewed with Licensee and a copy of this report must be made available for public review upon request.

Notice of site visit posted and shall remain posted for 30 days.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8867
LICENSING EVALUATOR NAME: Andrea MedlinTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: NADELMAN, AMINTA
FACILITY NUMBER: 414004252
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/20/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/22/2019
Section Cited
CCR
102418(g)
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102418(g) Immunization. Licensee shall document and maintain each child’s immunizations as long as the child is enrolled.

(Continued below)
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Licensee will send verification of children's current immunization records to the licensing office by 7/22/19.
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This requirement is not met as evidence of children's file reviews. C2, C3, C5, and C8, do not have immunizations available for review. This is a potential health and safety risk.
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Type B
07/22/2019
Section Cited
HSC
1596.8662(3)
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On and after January 1, 2018, a person who becomes an administrator or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs
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S2 will complete the mandated child abuse reporting training as compliant with AB1207 and submit to the licensing office by 7/22/19.
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(2) and (3) of subdivision (a) within the first 90 days of employment. This requirement is not met by review of records. S2 does not have the required mandated child abuse training. This poses a potential health and safety risk to children.
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For access to the training:

www.mandatedreporter.ca.com
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: Garfield LeungTELEPHONE: (650) 266-8867
LICENSING EVALUATOR NAME: Andrea MedlinTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: NADELMAN, AMINTA
FACILITY NUMBER: 414004252
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/20/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/22/2019
Section Cited
HSC
1597.622(a)(1)
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Commencing September 1, 2016, a person shall not be employed at a family day care home if he/she has not been immunized against influenza, pertussis, and measles.
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Verification of measels (MMR) immunization (or proof of immunity) for S2 will be sent to the licensing office by 7/22/19.
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This requirement is not met as evidene of staff file review. S2 does not have verification of the measels (MMR) immunization/immunity.This is a potential health and safety risk.
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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: Garfield LeungTELEPHONE: (650) 266-8867
LICENSING EVALUATOR NAME: Andrea MedlinTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4