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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004279
Report Date: 02/25/2022
Date Signed: 02/25/2022 02:25:32 PM


Document Has Been Signed on 02/25/2022 02:25 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:ROCHA, BARBARA M.FACILITY NUMBER:
414004279
ADMINISTRATOR:ROCHA, BARBARA M.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 712-9799
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94063
CAPACITY:14CENSUS: 8DATE:
02/25/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Barbara RochaTIME COMPLETED:
11:50 AM
NARRATIVE
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On February 25, 2022 at 9:00am, Licensing Program Analyst (LPA) Tapia-Mandujano conducted an unannounced required annual inspection. Purpose of the inspection was explained. LPA met with licensee, Barbara Rocha. Present in the facility is licensee and two assistants caring for 8 children (5 infants and 3 preschool age). All adults living and working in the home have a criminal record clearance on file.

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. The hours of operation are Monday-Friday 7:30-5pm. 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 toured day care areas of home with Licensee. LPA observed home to be clean and in good repair with proper temperature and ventilation. There were a variety of age appropriate toys and equipment in the home which were in good condition. Home does not have a fireplace. There were no pools, spas or bodies of water on the property. All cleaning supplies, poisons and other chemicals were stored inaccessible to children. Discipline Policy was discussed.

There was a fully charged fire extinguisher, smoke alarm and carbon monoxide alarm, and a working telephone on site. Phone number listed for Licensee is current. Per Licensee, there are no weapons or firearms in the home. LPA reviewed children’s records. LPA also reviewed facility and employee records. Licensees CPR & First Aid Certificate expires on 02/2024. Last emergency drill was conducted 01/2022. Emergency drills are conducted at least once every six months and are properly logged.

Incidental Medical Services (IMS) policy was discussed. Licensee does offer IMS 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 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.

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SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8864
LICENSING EVALUATOR NAME: Leslit Tapia-MandujanoTELEPHONE: (650) 350-2554
LICENSING EVALUATOR SIGNATURE:
DATE: 02/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/25/2022
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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Document Has Been Signed on 02/25/2022 02:25 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: ROCHA, BARBARA M.
FACILITY NUMBER: 414004279

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/25/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102416.5(d)(1)
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: (1) Twelve children, no more than four of whom may be infants; or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above as there are a total of 5 infant children present, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 02/28/2022
Plan of Correction
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Licensee will minimize the number of infant children present to only 4 infants at any given time. Licensee will aslo have a plan to ensure that there no more than 4 infant children present at any given time.
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) 266-8864
LICENSING EVALUATOR NAME: Leslit Tapia-MandujanoTELEPHONE: (650) 350-2554
LICENSING EVALUATOR SIGNATURE:
DATE: 02/25/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/25/2022
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: 02/25/2022
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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 tools, please send them by email 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/inforesources/community-care-licensing/process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.


**See following page for deficiencies cited against the facility today under CCR,Title 22, Div. 12, Chapt. 1**

Type “A” violations were issued today. Licensee is advised to provide a copy of the Evaluation Report and all 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 shall be maintained in all Children's files. Notice of site Visit wil be posted and should remain posted for 30 days, failure to post will result in an immediate civil penalty.


A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Barbara Rocha.
SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8864
LICENSING EVALUATOR NAME: Leslit Tapia-MandujanoTELEPHONE: (650) 350-2554
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2022
LIC809 (FAS) - (06/04)
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