414004901-5-26-2022-05-CC-CQUO-CESTNW-20220526145324

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004901
Report Date: 05/26/2022
Date Signed: 05/26/2022 02:54:19 PM

Document Has Been Signed on 05/26/2022 02:54 PM - It Cannot Be Edited

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:	TEJADA, GRACIELA Y. & TEJADA, MIGUEL A.		FACILITY NUMBER:	414004901
ADMINISTRATOR:	TEJADA, GRACIELA & MIGUEL		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 401-3821
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94403
CAPACITY:	14	CENSUS: 0	DATE:	05/26/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Graciela Tejada		TIME COMPLETED:	03:05 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	On May 26, 2022 at approximately 1:00pm, Licensing Program Analyst (LPA) Catrina Quimbo conducted an announced, pre-licensing inspection. LPA met with licensee, Graciela Tejada. No other individuals were present in the home at the time of inspection. Licensee is currently licensed (Fac #414002137). Due to an in home emergency, Licensee applied for a temporary relocation on 05/20/2022. Fire clearance for temporary relocation was received 05/25/2022. With licensee, LPA conducted a health and safety inspection inside and outside the home. Licensee will live in the home with co-licensee and spouse. All adults that will work and/or live in the home have criminal record clearance on file. Hours of operation will be Monday to Friday from 8:00am to 5:00pm. The home consists of 3 bedrooms, 2 bathrooms, living room, dining area, kitchen, play room, front yard, backyard and garage. The DAY CARE AREAS are bedroom #1 (infant napping room), bathroom #1 (located next to infant napping room), living room, dining area, kitchen, play room, front yard and backyard. The OFF-LIMITS AREAS are bedroom #2, bedroom #3, and bathroom #2 (located in bedroom #3), and garage. Off limit areas are properly barricaded with child safety gates and/or locked doors. LPA observed home to be clean, safe, in good repair, with proper temperature and ventilation. Home is equipped with age appropriate equipment and materials that were in good working condition. Home includes a fire place that is properly barricaded. Accessible electrical outlets are made inaccessible with child safety proof covers. All poisons, cleaning supplies and other hazardous materials are made inaccessible to children in care. LPA observed a working smoke and carbon monoxide detector, fully charged fire extinguisher, and fully stocked first aid kit. The entire backyard is enclosed with an at least 5 ft. high fence. LPA did not observe any bodies of water on site. (Continue on Page 2...)

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2022

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: TEJADA, GRACIELA Y. & TEJADA, MIGUEL A.	FACILITY NUMBER: 414004901
	VISIT DATE: 05/26/2022

NARRATIVE

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Licensee uses a designated cell phone and is aware the cell phone must stay within the home during the day care hours. Per licensee, there are no firearms or weapons in the home. Licensee will provide napping equipment for enrolled children. Laundering, sanitization, and COVID guidance was discussed. Licensee plans to isolate sick children in kitchen with a qualified employee, separate from other children in care. Licensee also plans to provide a food service.

Licensee was reminded baby walkers, bouncers, jumpers and any other similar items are not to be used for children in care. LPA also reminded licensee emergency drills are to be conducted and documented once every six months.

Licensees, Graciela Tejada and Miguel Tejada, have valid CPR and First Aid certificates that will expire 01/2024. Licensees Mandated Reporter training certificates are also current and will expire 2023.

Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

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

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SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2022

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: TEJADA, GRACIELA Y. & TEJADA, MIGUEL A.	FACILITY NUMBER: 414004901
	VISIT DATE: 05/26/2022

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Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.
To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

During inspection, licensee provided LPA copies of:
-Updated health and safety certificates for both licensees.
-Updated Mandated Reporter certificates for both licensees.
-Required immunizations for both licensees.
-Signed landlord consent form.
-Request to transfer cleared fingerprints for licensees and licensees' adult children.

Facility is recommended for licensure, effective 05/26/2022.

Licensee will inform department when licensee is to relocate back to Fac # 414002137. Prior to relocating back to Fac # 414002137, Fac # 414004901 must be closed under licensees names.

Exit interview conducted and report was reviewed with the licensee, Graciela Tejada.

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2022

LIC809 (FAS) - (06/04)

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