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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004462
Report Date: 01/10/2020
Date Signed: 01/10/2020 12:51:45 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:PORTILLO, JESSICA J.FACILITY NUMBER:
414004462
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 8DATE:
01/10/2020
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Jessica PortilloTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Van met with Licensee, Jessica Portillo, for an unannounced case management inspection. The purpose of the inspection was to process a capacity increase requested by the licensee. Present at the inspection is eight children, and licensee's two Aides (per licensee four are school-age children). The hours of operations are Monday through Friday, 8:30 AM - 5:30 PM. This facility has applied for a capacity increase from the capacity of 8 to 14. Landlord consent was obtained during the inspection.

LPA inspected the facility for Health and Safety Hazards. There are no pools, spas, or any other bodies of water at the facility. The facility has multiple smoke detectors, carbon monoxide detectors, and a fully charged fire extinguishers and a working telephone at the site. All the cleaning solutions, poisons, and other chemicals that are dangerous to the children are stored inaccessible to the children. All the materials and surfaces accessible to the children are clean and toxic-free. The facility has age-appropriate furniture. Furniture is steady and in good repair. The facility floor is in good repair and free of any hazards. Bathroom is in working condition with proper sanitation in place. The play-yard is free of hazards.

The department had received an approved fire clearance from the Burlingame Central County Fire Department on January 7, 2020. All required forms have been submitted to the department.

In today's inspection, LPA reviewed capacity requirements with the licensee. LPA also discussed the annual inspection checklist, a checklist was provided to licensee.

Capacity increase for large family child care home will be approved upon supervisor reviews.

A copy of this report was reviewed and provided to the licensee. Notice of site visit was observed to be posted and shall remain posted for 30 days.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon VanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2020
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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