434414668-3-18-2024-52-CC-MOTI-D3GSRD-20240318140609

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434414668
Report Date: 03/18/2024
Date Signed: 03/18/2024 02:06:18 PM

Document Has Been Signed on 03/18/2024 02:06 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	HERNANDEZ, MARIA DEL PILAR		FACILITY NUMBER:	434414668
ADMINISTRATOR:	HERNANDEZ, MARIA DEL PILAR		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 704-6266
CITY:	PALO ALTO	STATE: CA	ZIP CODE:	94306
CAPACITY:	14	CENSUS: 5	DATE:	03/18/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:20 PM
MET WITH:	Maria Hernandez		TIME COMPLETED:	02:25 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) Melanie Otsuji arrived to the facility unannounced on today's date, 03/18/2024, to conduct a Annual/Random inspection. LPA was met by Licensee, Maria Hernandez. Also present during today's visit were two fingerprint cleared assistants and 5 children (1 preschooler and 4 infant aged children). LPA conducted a health and safety inspection inside and outside. Facility's current hours of operation are: Monday through Friday 8:00AM - 5:00PM. The Family Child Care Home is a single story, single family house. The ON LIMIT areas are: the indoor patio (converted into activity room), the bedroom that is used for napping, the kitchen, the outdoor patio, and the backyard. Off limit areas are barricaded by way of closed doors and or gates. Outdoor play area is fenced and contains age appropriate play materials. The home has heating and ventilation for safety and comfort. There are no pools, hot tubs or any other bodies of water present during today's inspection. The home has a fully charged fire extinguisher. Facility has a working smoke detector and working carbon monoxide detector, and working telephone. The licensee is in compliance with the immunization law. Per licensee, there are no firearms in the home. All REQUIRED forms are posted and visible for public review. To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Melanie Otsuji	TELEPHONE: (510) 341-5559
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2024

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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: HERNANDEZ, MARIA DEL PILAR	FACILITY NUMBER: 434414668
	VISIT DATE: 03/18/2024

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Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days 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 PIN 22-02- CCP. 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: https://www.ada.gov/resources/child-care-centers/.
Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the Licensee, Maria Hernandez, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS. A notice of site visit was given and must remain posted for 30 days. No citations found on today's date.
Exit interview conducted and report was reviewed with the licensee Maria Hernandez.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Melanie Otsuji	TELEPHONE: (510) 341-5559
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2024

LIC809 (FAS) - (06/04)

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