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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004653
Report Date: 10/28/2021
Date Signed: 10/28/2021 02:11:10 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, ALBERTOFACILITY NUMBER:
414004653
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 3DATE:
10/28/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Gianella Perez PalmaTIME COMPLETED:
12:35 PM
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Licensing Program Analyst (LPA), Tapia-Mandujano conducted an unannounced inspection for increase of capacity today and met with assistant, Gianella Perez Palma for the request to increase from a Small to a Large Family Child Care. Fire Clearance is pending. LPA and assistant inspected entire home for Health and Safety Hazards.
Licensee rents home, which is a 3 bedroom, 2 bathroom, single level house. Licensee lives with Adult Daughter. All adults have criminal record clearance. Hours of operation are Monday-Friday 8am-5pm. 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.
Home has a working smoke detectors, a carbon monoxide detector, and a fully charged Fire Extinguisher. First Aid Kit is fully stocked and accessible. Facility has a working telephone. Phone number on file is updated. There is a small dog in the home. All harmful and sharp objects are made inaccessible from children in care. Licensee states there are no guns or weapons in the home. The home is clean and orderly with sufficient lighting and ventilation. Facility will conduct an emergency drill once every six months and log drills. Home has age appropriate toys and equipment available for the children in care. Postings will be in the living room. Assistant is reminded of NO walker, exersaucers, jumpers, bouncers and any similar items to be used for children in care and shall be made inaccessible. Assistant understands the capacity for Large Family Child Care License.
This report is discussed and explained to the applicant. Records to be Maintain in the facility was previously explained to use for all children in care. Mandatory Posting Requirements: License, Emergency Disaster Plan, Earthquake Preparedness, and Notification of Parents Rights Poster.
Prior to recommended for licensure, licensee must receive Fire Clearance from Menlo Park Fire Department.
Exit interview was conducted with assistant, Gianella Perez Palma. Copy of this report was emailed to the licensee at APAOLOPPL@HOTMAIL.COM. Signed copy of this report will be kept in the facility file and made available for public review. Desk Duty is available Monday through Friday between 8:00 AM - 5:00 PM at (650) 266-8800. Website for forms and Regulations: www.cdss.ca.gov
SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8864
LICENSING EVALUATOR NAME: Leslit Tapia-MandujanoTELEPHONE: (650) 350-2554
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021
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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