414004499-7-11-2019-05-CC-GSIH-BDYVFA-20190711162337

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004499
Report Date: 07/11/2019
Date Signed: 07/11/2019 04:23:42 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:	VILLENA, MARIE		FACILITY NUMBER:	414004499
ADMINISTRATOR:	VILLENA, MARIE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 822-8522
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94403
CAPACITY:	14	CENSUS: 4	DATE:	07/11/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	02:20 PM
MET WITH:	Marie Villena		TIME COMPLETED:	04:30 PM

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) Singh met with licensee, Marie Villena, for an annual random inspection. The purpose of the inspection was explained. Licensee lives in a single story home. Present, there are four children in care. 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 7:30 AM to 5:30 PM. LPA inspected the day care areas with the licensee. Day Care Areas: Room behind living room, Bathroom in hallway, Bedroom # 1 and Backyard. During the inspection, licensee requested to add the master bedroom into the licensed areas. LPA inspected the bedroom and bedroom is free of any hazard. Master bedroom is added to the day care areas starting today. 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 has child protective locks installed. Fireplace is in the off limit area and is barricaded with protective screen. 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. At 3:45 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 record of training of preventive health and CPR card valid until March 2020. Licensee has well maintained roster on file. LPA observed all of required documents are posted and are visible for the public. LPA remind the licensee to conduct the fire or emergency drills at least once every six months and drills must be logged. Licensee has completed the Mandated reporter training and has the completion certificate on file. Per certificate, training was completed on July 8, 2018. -- See next page for continuation ...

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Gagandeep Singh	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2019

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: VILLENA, MARIE	FACILITY NUMBER: 414004499
	VISIT DATE: 07/11/2019

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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 Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Gagandeep Singh	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2019

LIC809 (FAS) - (06/04)

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