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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004256
Report Date: 12/22/2022
Date Signed: 12/22/2022 03:58:31 PM


Document Has Been Signed on 12/22/2022 03:58 PM - It Cannot Be Edited

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: 13DATE:
12/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Neidemar MalazzoTIME COMPLETED:
04:10 PM
NARRATIVE
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On 12/22/2022 at 12:40PM., Licensing Program Analysts (LPA), Luis J. Gomez met with Licensee, Neidemar Malazzo. Purpose of the inspection was explained and was for an unannounced; Annual Random inspection. Present in facility was the licensee and two helpers caring for 13 children (9 Preschool Age, 4 Infant Age). Licensee’s home is a three bedroom, one bathroom one level house. Days and hours of operation are Monday- Friday, 8:30AM- 5:30PM. Daycare areas are: Living room (Playroom); Bedroom #1; Bathroom #1; and Backyard. Off Limit areas are: Kitchen (Pass Though only), Bedroom #2, #3, Garage and Laundry Room. LPA inspected home, inside and outside, with licensee for health and safety hazards.

At 12:50PM., the following was observed: Facility was clean, orderly, with age appropriate playthings available for the children. Floors and ground surfaces were clear of obstructions or potential hazards. Accessible furniture, toys and children’s books inspected were in good repair. Licensee has several child sized table and chairs for food services. Children's cubbies are located in entry way for storage of belongings. For napping services, LPA observed several cots and infant cribs (With tight-fitting sheets) stored in facility. Infant crib is available for each infant in care. Bathroom had adequate supplies for hand-washing. Fixtures tested were in operating condition. Off-limit areas have been made inaccessible with locked door and child safety gates installed. Facility was the proper temperature, with ventilation and lighting. Diaper changing table is located playroom. Per licensee table is disinfected after each use. Home had functioning telephone; smoke/ carbon monoxide combination detector; and fire extinguisher, 2A:10BC located in the garage. Detergents, cleaning compounds and toxins have been stored inaccessible to children.

At 1:20PM., LPA inspected the backyard. Area is completely enclosed with tall fencing. Outdoor playthings inspected were in proper repair. LPA reminded licensee to ensure trash and garbage is removed from backyard area. Outdoor play area does not any pools, fishponds, or bodies of water on the premises.


(REFER TO 809C, FOR CONT)
SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 12/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/22/2022
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 7


Document Has Been Signed on 12/22/2022 03:58 PM - It Cannot Be Edited

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: 12/22/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102416.5(d)(2)
Staffing Ratio and Capacity
(d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either: (2) More than twelve and up to fourteen children only if the criteria in Section 1597.465 of the Health and Safety Code are met.

This requirement is not met as evidenced by:
Deficient Practice Statement
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At 2:20PM., Based on record review, interviews, LPA confirmed licensee is over capacity stated on license with four infants (13 children) in care. This poses an immediate health and safety risk to children in care.
POC Due Date: 12/26/2022
Plan of Correction
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Licensee will reduce infant enrollment by the due date: 12/26/2022

Updated schedule/ roster (LIC9040) and updated schedule will be submitted to the Department via email. Registered parents must sign the LIC9224.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 12/22/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/22/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/22/2022 03:58 PM - It Cannot Be Edited

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: 12/22/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102370(d)(1)
Criminal Record Clearance
(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or

This requirement is not met as evidenced by:
Deficient Practice Statement
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At 2:40PM., Based on record review and interview, LPA confirmed employee present, S1, without proper fingerprint clearance on file. This poses a potential health and safety risk to children in care.
POC Due Date: 12/30/2022
Plan of Correction
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Licensee will ensure helper,S1, receives proper criminal record clearance prior to presence in facility. Proof of correction will be submitted to the department via email.
Type B
Section Cited
CCR
102425(j)(2)(D)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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At 2:30PM., Based on record review, LPA confirmed licensee is not maintaining documentation of infant napping conditions every 15 minutes. This poses potential health and safety risk to children in care.
POC Due Date: 12/30/2022
Plan of Correction
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Licensee will maintain documentation of napping conditions for infants in care by the due date:12/30/2022. Proof of correction will be submitted to department via email.
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: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 12/22/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/22/2022
LIC809 (FAS) - (06/04)
Page: 3 of 7


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: 12/22/2022
NARRATIVE
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(Page 2)
At 1:35PM, LPA reviewed facility and children’s records. Children’s files were reviewed and included the: Identification of Emergency Information (LIC700); Notification of Parent’s Rights (LIC995); and Notice of Additional Children in Care (LIC9150).

LPA reminded licensee to ensure proof of immunization are stored in children's files.



At 2:20PM., Based on record review, interviews, LPA confirmed licensee is over capacity stated on license with four infants (13 children) in care.

At 2:30PM., Based on record review, LPA confirmed licensee is not maintaining documentation of infant napping conditions every 15 minutes.

LPA reminded licensee to store helper's required licensing forms in facility files. Advisory Note: Technical Assistance (LIC9102TA) was issued.
LPA reminded licensee to complete the required 'Mandated Reporter Training' (AB1207). Advisory Note: Technical Assistance (LIC9102TA) was issued.

At 2:40PM., Based on record review and interview, LPA confirmed employee present, S1, without proper fingerprint clearance on file.

Licensee’s Cardiopulmonary Resuscitation (CPR)/ First Aid certifications were current expires 7/2024.
Licensee is conducting required emergency disaster drill every six months, with last drill logged on: 7/8/2022.

LPA reminded licensee to post the required forms in visible location for families.
Per licensee, isolation of ill children is in playroom.

Per licensee, she provides all foods services for children in care. LPA reminded licensee to ensure all children’s meal containers brought by families should be labeled.

Children medication was reviewed during inspection. Per licensee, home does not have any firearms.

(REFER TO 809C, FOR CONT.)

SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022
LIC809 (FAS) - (06/04)
Page: 6 of 7
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: 12/22/2022
NARRATIVE
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(Page 3)
LPA discussed the safe sleep regulations with licensee and discussed Child Care Licensing Safe Sleep Web page at:https://www.cdss.ca.gov/inforesource/child-care-licesning/public-information-and-resources/safe-sleep as an additional resource. LPA informed licensee of the importance of checking for recalled infant devices on United States consumer Product Safety Commission (CPSC) website at http://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tool, please send them to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesource/community-care-licensing/inspection-process.

Based on today's inspection, deficiencies were observed in areas evaluated according to California Title 22, Health and Safety Code of Regulations and cited on 809D. Exit interview, appeal rights, plan of correction and report was discussed with Licensee, Neidemar Melazzo, and signature of this form acknowledges receipt of these documents.



Type “A” violations were issued today. Facility is advised to provide a copy of the Evaluation Report and the Type “A” Deficiencies cited, to the parents and guardians of children currently enrolled in care and to parents of newly enrolled children during the next 12 months. A signed and dated LIC 9224 (Deficiency and Acknowledgment of Receipt of Licensing Reports) shall be maintained in all Children's files.

Notice of Site Visit was provided and must be posted for 30 days.

This report must be available in the facility for public review. Licensee was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766
SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022
LIC809 (FAS) - (06/04)
Page: 7 of 7