414004575-9-8-2022-05-CC-CQUO-CJ3PBH-20220908111023

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004575
Report Date: 09/08/2022
Date Signed: 09/08/2022 11:11:01 AM

Document Has Been Signed on 09/08/2022 11:11 AM - It Cannot Be Edited

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:	ESPINOZA, YADIRA		FACILITY NUMBER:	414004575
ADMINISTRATOR:	ESPINOZA, YADIRA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 315-4277
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94403
CAPACITY:	14	CENSUS: 8	DATE:	09/08/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Yadira Espinoza		TIME COMPLETED:	11:35 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 8, 2022 at approximately 8:15am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, annual inspection. LPA met with licensee, Yadira Espinoza, and explained the purpose of the inspection. Upon LPA's arrival, licensee, licensee's minor child and 2 enrolled children (2 infants) were present during inspection. Hours of operation are Monday through Friday 8:00-5:30pm. Licensee rents the home with spouse. The home is a multi-level, family home. The DAY CARE AREAS are located on the main level of the home. Day care areas include the living room, dining room, sun room, bathroom #1, front yard and upper level of backyard area. The OFF-LIMIT AREAS are all bedrooms on main level, bathroom #2, bathroom #3, side yard (pass through only), lower backyard, kitchen, garage and entire lower level of the home. Off limit areas are barricaded with locked doors. At approximately 8:30am, 2 additional enrolled children (preschool age) and licensee's assistant arrived to facility. With licensee, LPA inspected the home for health and safety hazards. LPA observed home to be in good repair with proper temperature and ventilation. Home is equipped with a variety of age appropriate toys and equipment that were in good condition. At approximately 9:00am, additional enrolled child (infant) arrived to facility. Home has a working smoke and carbon monoxide detector, fully charged fire extinguisher and working telephone on site. Phone number listed for licensee is current. At approximately 10:00am, additional enrolled child (infant) arrived to facility. LPA observed cleaning supplies, poisons and other chemicals to be stored inaccessible to children in home's high shelves and/or locked behind child safety locked cabinets. At approximately 10:15am, additional enrolled child (preschool age) arrived to facility. Present during inspection included 7 enrolled children (4 infants and 3 preschool age), licensee's minor child (preschool age), licensee, licensee's spouse, licensee's assistant and licensee's tenant. Licensee is operating within capacity limits and ratio during LPA's visit. All adults living and/or working in the home have fingerprint clearance on file. (Continue on Page 2...)

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 3

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: ESPINOZA, YADIRA	FACILITY NUMBER: 414004575
	VISIT DATE: 09/08/2022

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
26
27
28
29
30
31
32

(Continued, Page 2...)
Per Licensee, there are no weapons or firearms in the home. Home consists of 2 fireplaces which are properly barricaded and inaccessible to children in care.

The entire backyard is enclosed with an least 5ft high fence. Day care area of backyard is also fully fenced and is equipped with appropriate outdoor toys and equipment that are in good working condition. Outdoor area includes a chicken coop that is off limits and located in pass by area of backyard. Per licensee, enrolled children do not play or go near chicken coop. LPA observed chicken coop area to be clean and free of hazards.

Front yard also includes outdoor equipment that is age appropriate. LPA observed an age appropriate climbing structure that has sand underneath for resilient padding. Front yard has barricade that keeps enrolled children away from street side.

LPA reviewed nine children’s records which were complete. Children’s files have a record of emergency identification information on file. LPA reviewed licensee and licensee's assistant's files which were complete. Both licensee and assistant have a current and valid CPR certificate. Licensee's CPR certificate will expire 11/2022. LPA also reviewed licensee's spouse, licensee's mother, and licensee's tenant's files that were complete with required immunizations.

Last emergency drill conducted was 07/12/2022. Emergency drills are conducted at least once every six months and are properly logged. Licensee maintains safe sleep logs for napping infants. Safe sleep logs are properly documented and logged for each napping infant that includes the 15 minute time check of when the infant sleeps as well as their napping position.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) / (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: www.ada.gov/childqanda.htm.
(Continue on Page 3...)

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: ESPINOZA, YADIRA	FACILITY NUMBER: 414004575
	VISIT DATE: 09/08/2022

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
26
27
28
29
30
31
32

(Continued, Page 3...)

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

No deficiencies were cited today under CCR, Title 22, Div. 12, Chapt. 1.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

An exit interview conducted and report was reviewed with the licensee, Yadira Espinoza.

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022

LIC809 (FAS) - (06/04)

Page: 3 of 3