414004652-12-3-2019-05-CC-CINO-BJHPHT-20191203102028

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004652
Report Date: 12/03/2019
Date Signed: 12/03/2019 10:20:33 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:	VALENCIA, KARLA G.		FACILITY NUMBER:	414004652
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	12/03/2019
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Licensee, Karla Valencia		TIME COMPLETED:	10:40 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	Licensing Program Analyst (LPA), Cindy Interiano, conducted a scheduled PreLicensing inspection this day and met with Licensee, Karla Valencia. Licensee has relocated from facility #414004247 to this current location. LPA and Licensee inspected entire home for Health and Safety Hazards. Licensee rents home, which is a 3 bedroom, 2 bathroom, single level house. Licensee has provided proof of control of properly. Licensee lives with minor child and roommate. Daycare areas are: Living Room, Bathroom #1, Dining area, (converted) Garage, Sideyard #1 (adjacent to Garage), and Backyard. Off limit areas are: Kitchen, Laundry area (in Garage), Master Bedroom #1 with Bathroom #2, Bedroom #2, Bedroom #3, Sideyard #2 (adjacent to Bedroom #3), and all closets. All off limit areas are properly barricaded. Home has a working smoke and carbon monoxide detector, a working telephone, and a fully charged fire extinguisher. Home also has a local ‘Fire pull alarm’ system. First Aid kit is fully stocked and accessible. All harmful and sharp objects are made inaccessible from children in care. Licensee states there are no guns or weapons in the home. Home is clean and orderly, with sufficient lighting and ventilation. Licensee states she conducts an emergency drill once every six months and logs drills. Home has a fireplace in the living room, which is properly barricaded. Home has no bodies of water. Home has age appropriate toys and equipment available for the children in care. Licensee states discipline policy is redirection. Licensee’s CPR expires in 11/2021. Postings are posted near main entrance of the home. Licensee is reminded of NO walker, exersaucers, jumpers, bouncers, and any similar items to be used for children in care and shall be made inaccessible. Licensee is advised all adults, 18 years and older living in the home, Helper, or assistant must have criminal record clearance and must be associated to the facility by submitting an LIC 9182 with copy of CDL or Ca. ID prior to having any contact with the children in care and failure to do so could result in an immediate civil penalty of $100.00 each day. See Page 2. . .

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/03/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2019

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: VALENCIA, KARLA G.	FACILITY NUMBER: 414004652
	VISIT DATE: 12/03/2019

NARRATIVE

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Page 2. . .

During inspection,
*Incidental Medical Services (IMS) policy was discussed.
*Licensee was reminded about having all Staff and Volunteers provide proof of immunization against influenza, pertussis, and measles or qualifies for an exemption.
*Licensee was reminded about the Provider Information Notices (PINs) on CCLD website.
*Licensee was reminded about Mandated Reporter Training available on CCLD website
(www.ccld.ca.gov or www.mandatedreporterca.com). Licensee states she will take the training once it is available in Spanish.
*Licensee was advised of the new Lead Bill (effective 01/01/19), requiring Facilities to distribute a two-page flyer to Guardians with information on lead poisoning facts.
*Licensee was given information regarding ‘Safe Sleep’ practices.

This report is discussed and explained to the Licensee. Records to be Maintain in the facility was previously explained and provided to Licensee (in English and Spanish) to use for all children in care. Mandatory Posting Requirements: License, Emergency Disaster Plan, and Notification of Parents Rights Poster.

Capacity limits of a Small and Large License has been reviewed with Licensee.
Licensee may apply for a Large license in the future.

Small Family Child Care License is approved and will be effective as of today, 12/03/19.

This report will be kept in the facility file and will be made available for public review upon request. Desk duty is available Monday - Friday, 8:00a.m.- 5:00p.m. (650) 266-8800.

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/03/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2019

LIC809 (FAS) - (06/04)

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