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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004492
Report Date: 08/15/2019
Date Signed: 08/15/2019 04:27:16 PM

COMPREHENSIVE INSPECTION
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:OSBORNE, LILLIANE M.FACILITY NUMBER:
414004492
ADMINISTRATOR:OSBORNE, LILLIANE M.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 393-4753
CITY:SAN MATEOSTATE: CAZIP CODE:
94403
CAPACITY:14CENSUS: 7DATE:
08/15/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Lilliane OsborneTIME COMPLETED:
04:40 PM
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Licensing Program Analyst (LPA) Singh met with licensee, Lilliane Osborne, for an annual random inspection. The purpose of the inspection was explained. Licensee lives in a single family home. Present, there are seven preschool age children in care with licensee and one helper. All adults living or working in the home have criminal background check on file. Licensee is operating within the capacity of this date. Licensee provides day care from Monday to Friday between 8:30 AM to 4:30 PM.

LPA inspected the day care areas with the licensee. Day Care Areas: Main Room, Living Room, Bathroom, Bedroom next to living room, Dining Area, Kitchen, Bathroom next to kitchen and yard, which is behind, on side and front of the house. Off limit areas: Master Bedroom, Bedroom # 1, Bedroom # 2, Garage and Cabin in backyard. There is no pool, spa or any other body of water in the house. As per licensee, there is no firearm or weapon in the house. All the cleaning supplies, poisons and other chemicals are stored inaccessible to the children. Cabinets in the bathroom ahs child protective locks installed. There is no fireplace and stairs in the house. The house is in good repair and free of hazards with proper temperature and ventilation. There is carbon monoxide detector, smoke detector, fully charged fire extinguisher and working telephone available in the house. There is a variety of age appropriate toys in the house. Unused electric outlets have child protective covers. Stove in kitchen has covers on the knobs, preventing any access from the children.

At 3 PM, LPA review the children's record. LPA reviewed the identification and emergency information form for every child for proper names and numbers filled. Licensee has record of immunization of each child in care. Licensee has well maintained roster on file. Licensee has record of training of preventive health and CPR card valid until April, 2021. Licensee has log for fire and emergency drills. Per log, last drill was conducted on May 07, 2019. Licensee has submitted the proof of her immunization and mandated reporter training during previous inspection. LPA observed licensee has all of required documents posted at the entrance and are visible for the public. See next page for continuation ...............
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Gagandeep SinghTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2019
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: OSBORNE, LILLIANE M.
FACILITY NUMBER: 414004492
VISIT DATE: 08/15/2019
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Continuation from previous page .........................

LPA encourage the licensee to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. Licensee can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

No deficiencies are cited today. The copy of this report is reviewed and provided to the licensee. Notice of site visit is posted and shall remain posted for next 30 days.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Gagandeep SinghTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2019
LIC809 (FAS) - (06/04)
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