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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004665
Report Date: 10/12/2021
Date Signed: 10/12/2021 04:47:43 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:QUINTERO, ROSALBAFACILITY NUMBER:
414004665
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 4DATE:
10/12/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:Rosalba Quintero, America CancholaTIME COMPLETED:
04:55 PM
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Licensing Program Analyst (LPA) Andrea Medlin met with Licensee for this case management visit today due to request to increase capacity to a large family child care home (FCCH). There are 4 children present during the visit; 1 infant and 3 preschool aged. The South San Francisco Fire Department has approved the fire clearance on 9/1/2021. Days and hours of operation: Monday-Friday 7:00AM--5:00PM. Licensee states she, one adult daughter, and one minor child reside in the home; criminal record clearance is on file for all adults. Licensee reminded once a person turns 18 years old, and if living or working in the home, criminal record clearance is required. Physical plant toured to inspect for health and safety hazards. The home has smoke detectors, fully charged fire extinguishers, and a carbon monoxide (CO) detector. Outdoor space inspected for health and safety hazards; outdoor play area is completely fenced. The daycare areas used are: living room//family room converted into daycare use, one bathroom, one bedroom (minor daughters room) may be used for daycare children to nap only; and outside backyard designated areas. The sandbox must either be covered or checked daily before children's use to remove any hazardous items. First aid supplies are available. Detergents, cleaning compounds, medications, and other items which could pose a danger to children is stored inaccessible to children. The daycare areas are kept clean and orderly and has adequate heating and ventilation for safety and comfort. Per Licensee, there are no pets and no firearms or weapons in the home. No spas, swimming pools, hot tubs, fish ponds, or similar bodies of water are present. Variety of age appropriate toys and materials is observed in the daycare. Licensee has current Pediatric First Aid and CPR certification (exp 10/2023); the required staff immunizations: measels (MMR) and pertussis (Tdap); and has verification of the mandated child abuse reporting requirement training (exp 8/7/2023) as compliant with AB1207. In addition, licensee's helper also has current Pediatric First Aid/CPR (exp 10/2023) and verification of the mandated child abuse reporter training (exp 8/23/2023) compliant with AB1207. All the required licensing forms are centrally posted. If Licensee provides care to the 13th and 14th child, children must be school aged (6 years or older), and Landlord Consent and Parent Notification is required.

(Continued next page 809-C)
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Andrea MedlinTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2021
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 2
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: QUINTERO, ROSALBA
FACILITY NUMBER: 414004665
VISIT DATE: 10/12/2021
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This home meets the licensing requirements of a Large Family Child Care Home and re-licensure to a Large Family Child Care Home is recommended and approved as of today, 10/12/2021.

This report is reviewed with Licensee and a copy of this report must be made available for public review upon request.

Notice of Site Visit posted and shall remain posted for 30 days.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Andrea MedlinTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2021
LIC809 (FAS) - (06/04)
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