414004653-1-24-2020-05-CC-CINO-BL5SFA-20200124125001

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004653
Report Date: 01/24/2020
Date Signed: 01/24/2020 12:50:12 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:	PEREZ-PALMA, ALBERTO		FACILITY NUMBER:	414004653
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	01/24/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	11:10 AM
MET WITH:	Applicant, Alberto Perez-Palma		TIME COMPLETED:	01:10 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), Cindy Interiano, conducted a scheduled PreLicensing inspection and met with Applicant, Alberto Perez-Palma. LPA and Applicant inspected entire home for Health and Safety hazards. Applicant rents home, which is a 3 bedroom, 2 bathroom, single level house. Applicant lives with Adult Daughter. All adults have criminal record clearance. Daycare areas are: Living Room, Bathroom #1, Bedroom #1, Dining area, and Backyard. OFF limit areas: Front yard and Driveway, Garage, Bedroom #2, #3, Bathroom #2 (inside Bedroom #3), Kitchen (pass by only to backyard), and Side yards. All off limit areas, including all closets are properly barricaded. First Aid is fully stocked and accessible. Home does not have any fireplace or bodies of water. Wall heaters in the Living room and Hallway are properly barricaded. All harmful and sharp objects are made inaccessible from children in care. Applicant states there are no guns or weapons in the home. The home is clean and orderly with sufficient lighting and ventilation. Applicant states he will conduct an emergency drill once every six months and log drills. Applicant’s CPR expires in 12/2021. Home has age appropriate toys and equipment available for children in care. Applicant states discipline policy is mainly redirection. Postings will be in the Living room area. Applicant is reminded of NO walkers, exersaucers, jumpers, bouncers, and any similar items to be used for children in care and shall be made inaccessible. Applicant 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 children in care and failure to do so could result in an immediate civil penalty of $100.00 each day. Applicant was informed that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662. 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: 01/24/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2020

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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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: PEREZ-PALMA, ALBERTO	FACILITY NUMBER: 414004653
	VISIT DATE: 01/24/2020

NARRATIVE

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Page 2. . .

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: http://www.ada.gov/childqanda.htm

Applicant was advised about Mandated Reporter Training available on CCLD
website (www.ccld.ca.gov or www.mandatedreporterca.com).

Applicant was advised of the new Lead Bill (effective 01/01/19), requiring Facilities to distribute a 2-page flyer to Guardians with information on lead poisoning facts.

Applicant was given information regarding ‘Safe Sleep’ practices.

Applicant was advised about the Provider Information Notices (PINs) on CCLD website.

This report is discussed and explained to the Applicant. Records to be Maintain in the facility is explained and left with the Applicant to use for all children in care (in English and Spanish). Mandatory Posting Requirements: License, Emergency Disaster Plan, and Notification of Parent's Rights Poster.

During inspection, Applicant provided:
*updated Application (LIC 279)
*proof of immunization: Measles (MMR), Whooping Cough (Tdap), Flu
*copy of Preventative Health and Safety training certificate
*copy of CPR card expiring in 12/2021

Capacity limits of a Small Family Child Care License has been discussed.

Small Family Child Care Home License is approved and will be effective as of today, 01/24/2020.

This report will be kept in the facility file and will be made available for public review upon request. Desk duty is available M-F, 8a.m.-5p.m., (650) 266-8800. Website for forms and Regulations: www.cdss.ca.gov

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2020

LIC809 (FAS) - (06/04)

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