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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004768
Report Date: 02/16/2021
Date Signed: 02/16/2021 01:48:26 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:SANDINO, ADELAFACILITY NUMBER:
414004768
ADMINISTRATOR:SANDINO, ADELAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 347-7300
CITY:DALY CITYSTATE: CAZIP CODE:
94015
CAPACITY:14CENSUS: 0DATE:
02/16/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Adela SandinoTIME COMPLETED:
09:30 AM
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Licensing Program Analyst, LPA Yee conducted a telephone conference inspection today. This is a change of location from San Francisco to Daly City. LPA and the applicant did a visual tour inspection. The residents in this home are Adela, her mom, her cousin, and her 17-year-old daughter. The home is leased and the lease agreement is on file. Landlord notification/consent is on file. Day-care areas (street level): living room, kitchen, bathroom, outdoor yard, and family room (upper level). Off limit: Bedroom #1, #2, #3, #4, laundry room, and bathrooms located on the upper level. Fire extinguishers, smoke detectors, carbon monoxide are available. LPA advised Adela to conduct an emergency drill once every 6 months and keep a log sheet. CPR & 1st aid certificate is current. The home has age-appropriate toys and equipment available for the children in care. The form of discipline was discussed. Mandated Reporter Training, AB1207 certificate is on file. LPA reminded Adela that all staff members must take the training and keep the certificate on file. The training needs to be renewed once every 2 years. Child Abuse Mandated Reporter Training, AB1207. www.mandatedreporterca.com.
SIDS "A Child Care Provider's Guide to Safe Sleep" was discussed. A packet of records to be maintained and posting requirements were explained and provided. Website for forms and regulations: www.ccld.ca.gov

COVID-19 Self-Assessment Guide and posting requirements were discussed. This facility provides Incidental Medical Services - IMS. LPA reviewed storage of medication and equipment/supplies and reviewed children's, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 102417. 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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, Available at http://www.ada.gov/childqanda.htm

LPA received the fire clearance approval today. LPA will recommend a large license effective today, 2/16/2021.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 02/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2021
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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