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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414668
Report Date: 12/10/2021
Date Signed: 12/10/2021 02:12:22 PM

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 PILARFACILITY NUMBER:
434414668
ADMINISTRATOR:HERNANDEZ, MARIA DEL PILARFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 704-6266
CITY:PALO ALTOSTATE: CAZIP CODE:
94306
CAPACITY:14CENSUS: 8DATE:
12/10/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Maria Del Pilar Hernandez TIME COMPLETED:
02:11 PM
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On 12/10/2021 at 9:30am Licensing Program Analyst (LPA) Sabina Dodoo met with licensee Maria Del Pilar Hernandez for an UNANNOUCED ANNUAL REQUIRED INSPECTION for a Family Child Care Home. Present for the inspection were 3 staff members (including licensee) who are all fingerprint cleared and associated. The total children enrolled are 9 and the census was 8 at the time of the inspection. The Family Child Care Home is within ratio. The Family Child Care Home was toured to conduct a Health and Safety Inspection. The center currently operates Monday through Friday from 8:00am to 5pm.

The Family Child Care Home is a single story home with an attached garage, with 3 bedrooms and one bathroom. One of the bedrooms has been converted into a napping area for the children. It has cribs that are see through and fitted mattresses. The indoor patio has been converted into an activity room. The outdoor patio has benches with tables appropriate for children to sit and eat. The play area is the backyard which is fenced all around. The play area has two small fenced play areas for the infants, a slide structure and a play house. There is a green astro turf all around the play structure to absorb falls. There are chairs and tables equipped for children in the activity area. The entrance of the Family Day Care Home is the main door to the house. The parents punch in a code at the door specific for their children to enter the home. This information is then transmitted to an app called the August App so parents can sign in and out. LPA (Dodoo) observed the activity room to be neat with proper ventilation and materials equipped to care for the children. LPA (Dodoo) observed the bulletin board (parent’s rights, emergency disaster plan, earthquake drills and facility license). The activity area has a diaper changing table, and cubbies with children’s names on them. There are no bodies of water or firearms on the premises. All chemicals, sharp objects (knives or scissors) are kept out of reach of the children.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Sabina DodooTELEPHONE: 510-622-2602
LICENSING EVALUATOR SIGNATURE:

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

DATE: 12/10/2021
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 4
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: 12/10/2021
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The OFF-LIMIT AREAS are 2 of the bedrooms and the garage.

The ON-LIMIT AREAS are the activity area(indoor patio), the bedroom that is used for napping, the kitchen, the outdoor patio, and the backyard.

All hazardous materials and toxins are kept out of reach from children and are not accessible. The Family Child Care Home has a fully charged fire extinguisher 3A-10- 40 BC, a working smoke detector, working carbon monoxide, telephone and fully stocked first aid kits. The furniture around the classroom is child proof and the toys are stored in safety bins that can be easily accessed by the children.

The licensee and staff have completed the Health and Safety training and CPR/First Aid is current. The licensee and the aides are following the immunization laws and have completed the mandated reporter training. The Licensee conducts and documents fire and disaster drills twice a year and the last conducted drill was in October of 2021. All required forms are posted and visible for public view.

At 12pm LPA (Sabina Dodoo) reviewed 4 children’s files and 3 staff files and documented them on LIC 857 and LIC 859. An updated roster will be emailed to LPA by the licensee. The staff interview was completed with Licensee Maria Hernandez.

SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Sabina DodooTELEPHONE: 510-622-2602
LICENSING EVALUATOR SIGNATURE:

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

DATE: 12/10/2021
LIC809 (FAS) - (06/04)
Page: 4 of 4
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: 12/10/2021
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Incidental Medical Services (IMS) policy was discussed. This facility does not provide IMS (Incidental Medical Services) to children at this time. If 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

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

Licensee was reminded that all adults 18 and over working in Child Care Center, 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 Child Care Center. 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.

SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Sabina DodooTELEPHONE: 510-622-2602
LICENSING EVALUATOR SIGNATURE:

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

DATE: 12/10/2021
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: 12/10/2021
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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.

Licensee was reminded of the responsibility as a mandated reporter and the trainings must be done once every two years as well as CPR/First Aid needs to be renewed every two years and must be EMSA approved. LPA also encouraged licensee to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, as well as all forms can be downloaded. For licensing updates and Quarterly Child Care Distribution email, email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list.

Effective August 1, 2003 California Law requires Child Care licensees to report unusual incidents or injuries to children in care to child’s parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours to the regional office by phone and the written report, LIC 624 within 7 business days.

There were no deficiencies cited during today’s inspection. A notice of site visit was given and must remain posted for 30 days. Exit Interview and staff interview was conducted with Licensee (Maria Hernandez) at 1:45pm. This report shall remain on file for the next 3 years.

SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Sabina DodooTELEPHONE: 510-622-2602
LICENSING EVALUATOR SIGNATURE:

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

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