414004279-3-10-2020-05-CC-CINO-BMKNUQ-20200310104644

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004279
Report Date: 03/10/2020
Date Signed: 03/10/2020 10:46:48 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:	ROCHA, BARBARA M.		FACILITY NUMBER:	414004279
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 6	DATE:	03/10/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:55 AM
MET WITH:	Licensee, Barbara Rocha		TIME COMPLETED:	11:00 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), Cindy Interiano, met with Licensee, Barbara Rocha for a 1 year Annual inspection. Purpose of the inspection was explained. LPA arrived at 8:55am and observed Licensee and Helper caring for 6 children (3 infants and 3 PreK). Licensee is within capacity limits of a Small capacity License. Facility is pending for a Large Capacity license. Licensee rents home, which is a two unit home. Front Unit ‘B’ has 2 rooms and 1 Bathroom. Unit ‘A’ in the back has two levels and has 4 bedrooms and 2 bathrooms. Units are connected by the Laundry room. Property has a two-car detached garage. Licensee lives with Husband and 3 minor children. All adults have criminal record clearance. Daycare areas are: Front Unit 'B': Living room, Room #1, Room #2 with Bathroom #1, Front yard, and portion of Side yard/Driveway. OFF limit area: Unit 'B': Kitchen, Laundry area, portion of side yard/driveway, and backyard; and Entire Unit 'A'. Side yard/Driveway is divided by a ‘retractable’ gate. All off limit areas, including closets, are properly barricaded. LPA observed the following: Daycare area is clean, orderly, and equipped with age appropriate toys and equipment for the children. Home has sufficient lighting and ventilation. Home has a working telephone, a working smoke and carbon monoxide detector, and a fully charged fire extinguisher. Home has no fireplace or bodies of water. There are no poisons, detergents, or cleaning products accessible to daycare children. Licensee states there are no guns/weapons in the home. Licensee’s CPR expires in 11/2020. Licensee conducted last emergency drill on 02/22/20 and is properly logged. Licensee offers daily snacks and meals. Discipline policy is mainly redirection. All required postings are properly posted. Licensee and Helper have required proof of immunization on file, as well as Mandated Reporter training certificate. Children’s files were reviewed at 10:00a and are complete and up-to-date. See Page 2. . .

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2020

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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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: ROCHA, BARBARA M.	FACILITY NUMBER: 414004279
	VISIT DATE: 03/10/2020

NARRATIVE

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Licensee provided a document and email dated 08/15/19 sent from Fire inspector stating fire clearance has been granted. LPA will follow up with Fire Inspector to receive the final Fire clearance approval. Once received, LPA will send Licensee and updated Large Capacity License.
Capacity limits of a Large (and Small) capacity License has been discussed with Licensee.

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 advised of the new Lead Bill (effective 01/01/19), requiring Facilities to distribute a two-page flyer to Guardians with information on lead poisoning facts.
*Licensee was given information regarding ‘Safe Sleep’ practices.

>No deficiencies were 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) 266-8800
LICENSING EVALUATOR NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2020

LIC809 (FAS) - (06/04)

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