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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004256
Report Date: 11/22/2019
Date Signed: 11/22/2019 03:12:14 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:MELAZZO, NEIDEMAR A.FACILITY NUMBER:
414004256
ADMINISTRATOR:MELAZZO, NEIDEMAR A.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 685-8270
CITY:SAN MATEOSTATE: CAZIP CODE:
94402
CAPACITY:14CENSUS: 11DATE:
11/22/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Licensee, Neidemar A. MelazzoTIME COMPLETED:
03:25 PM
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Licensing Program Analyst (LPA), Luis J. Gomez met with Neidemar A. Milazzo. Purpose of the inspection was explained to licensee and is for an unannounced annual inspection. Present in the facility is licensee, her husband and two helpers caring for 11 children (5 Infants 6 Preschool age). Licensee's son (School age) arrived during inspection. All adults in the home have their criminal record clearance on file. Licensee’s home is a 3- bedroom, 1- bathroom 1- story house. Hours of Operation are: Mon- Fri: 7:00am- 6:00pm. Daycare areas: Living room, Bedroom #1, Bedroom #2, Bathroom and Backyard. Off Limit areas are: Kitchen (Pass Though only), Bedroom #3, Garage and Laundry Room.

At 12:55pm on November 22, 2019 LPA inspected the home for health and safety hazards with the licensee. Daycare area has a variety of age appropriate toys, games and blocks for the children. There are cubbies available for children’s belongings. Home is clean, with proper temperature and ventilation. There are several child size tables and chairs. Bedroom #1 is equipped with six cribs. Bedroom #2 has 4 pack-n- plays for napping infants. Bathroom #1 is kept clean, in good repair, and maintained with adequate supplies. Licensee has installed safety locks on cabinet under the sink. Licensee has installed child safety gates to all off limit areas. Backyard is free of defects or dangerous conditions. Licensee installed child safe padding on all corners for extra safety. Licensee stated she prepares all daily snacks and meals. Per licensee, there are no guns or weapons in the home. All cleaning supplies, poisons and other chemicals are stored inaccessible to children. Home has a working telephone, a smoke detector, carbon monoxide detector, and a fully charged fire extinguisher located in the laundry room.

(Continuation on page 809-C)
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2019
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: MELAZZO, NEIDEMAR A.
FACILITY NUMBER: 414004256
VISIT DATE: 11/22/2019
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(Page 2)
Eleven children's and two personnel files were reviewed. The children files were complete and had all required immunization's and emergency identification information. Facility roster was reviewed and is complete. Emergency drills are done at the facility with the last drill conducted on, 11/20/2019, and properly logged. At 1:52pm on November 22, 2019, based on a file review, LPA observed licensee is over capacity with 5 infant age children in care. At 1:55pm, LPA observed licensee was reminded to renew CPR/ 1st aid certification.

Incidental Medical Services (IMS) was discussed. Licensee has no children who need services at this time. 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 Americans with Disabilities Act (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: www.ada.gov/childqanda.htm.

During inspection,
· 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 reminded 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 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

Based on today's inspection, deficiencies were observed in the areas evaluated according to the Title 22 Division 12 Ca. Code of Regulations. A plan of correction was developed with the licensee and exit interview was conducted with, Neidemar Melazzo and her signature of this form acknowledges receipt of these documents.



>This report and rights to comment and appeal were discussed with Site Supervisor. This report must be available in the facility for public review. Notice of site inspection was posted.
Site Supervisor was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2019
LIC809 (FAS) - (06/04)
Page: 2 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: MELAZZO, NEIDEMAR A.
FACILITY NUMBER: 414004256
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/22/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/25/2019
Section Cited

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102416.5(a) Staffing Ratio and Capacity. The capacity specified on the license shall be the maximum number of children for whom care can be provided. This requirement is not met as evidenced by.
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Based on observations and a file review, LPA confirmed licensee is overcapacity with 5 infants in care. This is an immediate health and safety risk to children in care.
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Licensee will submit proof of correction to LPA Gomez via email.

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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: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 11/22/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/22/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3