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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004521
Report Date: 01/08/2020
Date Signed: 01/08/2020 03:57:53 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:HERRERA, TULA & CACERES, JENIFFERFACILITY NUMBER:
414004521
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 4DATE:
01/08/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Herrera,Tula and Caceres, JenifferTIME COMPLETED:
04:10 PM
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Licensing Program Anaylst (LPA) Jyoti Saini met with Licensee Herrera Tula and Caceres Jeniffer for Annual Random inspection.The purpose of the visit was explained. Present, there are 4 children in care with the Licensee. All adults living or working in the home have criminal background check on file. Licensee provides day care from Monday to Friday between 7:30AM to 5:30PM.
LPA and Licensee inspected entire home for Health and Safety Hazards. Licensee rents home, which is a three bedroom, one bathroom, single level house. Licensee live in the home with another adult. Daycare area is: Bathroom #1, Dining Area, ‘Indoor’ Playroom, Room #3/Nap room, ‘Outdoors’ Playroom. OFF limit areas: Living Room, Kitchen, Garage, Backyard, and Storage Cabin in the Backyard. All off limit areas are properly barricaded and made inaccessible to the children in care.
LPA observed following:
The house is in good repair and free of hazards with proper temperature and ventilation. with fully charged fire extinguisher and working telephone available in the house. There is a variety of age appropriate toys in the house. Licensee provides Breakfast, Lunch, snacks and dinner. Facility has all postings. A current children's roster was observed by the LPA. First Aid kit available in the home. Licensee has the CPR and First Aid training valid until 08/27/2020. Children files contained immunization records and emergency contact information. Licensee will be applying for a large license soon. LPA explained the process for large family day care license.
Applicants were reminded about the Provider Information Notices (PINs) on the CCLD website.
LPA encourage the facility to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. Facility can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.
>No deficiencies were issued today under Title 22 Division 12 of the California Code of Regulations.
>This report and rights to comment and appeal were discussed with Licensee. This report must be available in the facility for public review. Notice of site visit shall be posted for 30 days from today's visit.
Licensee was advised for any additional questions to call Office, M-F, 8:00AM-5:00PM at 650-266-8800 . For Rules and Regulations, visit the Website: www.cdss.ca.gov
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jyoti SainiTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2020
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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