414004499-9-7-2021-05-CC-CQUO-C6MNW7-20210907104902

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004499
Report Date: 09/07/2021
Date Signed: 09/07/2021 10:49:39 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:	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: 8	DATE:	09/07/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Licensee, Marie Villena		TIME COMPLETED:	10:30 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	On September 7, 2021 at 9:00am, Licensing Program Analyst (LPA) Catrina Quimbo met with licensee, Marie Villena, for a scheduled case management inspection. Present in the home is licensee, licensee’s helper (H1), licensee's adult daughter, and 8 enrolled children (4 infants and 4 preschoolers). All adults living and working in the home have criminal background clearance on file. Licensee is currently licensed for a large license with a capacity of 14 children. Hours of operation are Monday to Friday 7:30am to 5:30pm. Licensee requested to add living room as part of the day care area. LPA and Licensee inspected all day care areas for health and safety hazards. Licensee rents home. Licensee lives in single level home with adult daughter. Home consist of 3 bedrooms, 2 bathrooms, 1 living room, 1 family room, 1 dining room, 1 kitchen, 1 backyard and garage. Day care areas now to be used are: bedroom #1 (baby room), bathroom #1, bedroom #3 (master bedroom), family room, living room and backyard. OFF LIMIT areas are: bedroom #2 (located in between bedroom #1 and bedroom #3), bathroom #2 (located in master bedroom), kitchen, dining room, and shed (located in backyard). All off limits areas are made inaccessible to children by locked doors and/or child safety gates. LPA observed home to be in good repair with proper temperature and ventilation. There were a variety of age appropriate toys and equipment in the home which are in good condition. All electrical outlets accessible to children have child safety covers. All cleaning supplies, poisons and other chemicals were stored inaccessible to children. Cabinets and drawers accessible to children have child safety locks. Living room has a fireplace barricaded with a protective screen. (Continue on Page 2...)

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8864
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: (650) 393-8293
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2021

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: 09/07/2021

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Fire extinguisher is fully charged and accessible. Home has a functioning smoke and carbon monoxide detectors. Discipline policy, COVID-19 guidelines and updated safe sleep regulations were discussed. Licensee was reminded to document safe sleep logs for napping infants, conduct emergency drills once every six months and to renew Mandated Reporter training every 2 years. Licensee was advised to check CCLD website for any updates and/or provider information notices (PINs).

Prior to department's approval of living room as day care area, licensee must:
-place additional padding on fire place edges
-cover heater vent in floor.

After today’s inspection, an exit interview was conducted with licensee, Marie Villena. This report is public and can be reviewed. Copy of this report was provided to licensee at marie.villena@yahoo.com. 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: Cindy Interiano	TELEPHONE: (650) 266-8864
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: (650) 393-8293
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2021

LIC809 (FAS) - (06/04)

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