435700327-2-2-2021-52-CC-MESA-BXUPYN-20210202104409

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 435700327
Report Date: 02/01/2021
Date Signed: 02/02/2021 10:44:17 AM

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:	MABILANGAN, SUSANA		FACILITY NUMBER:	435700327
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 3	DATE:	02/01/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Susana Mabilangan		TIME COMPLETED:	05:00 PM

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As per PIN 20-08-CCP that beginning March 26, 2020 Licensing Program Analysts (LPAs) will conduct tele-inspections as part of Community Care Licensing Division’s (CCLD) emergency response to the spread of Coronavirus Disease 2019 (COVID-19).

On 02/01/2021 at 2:30 pm, Licensing Program Analyst (LPA) Manel Estoesta conducted an announced tele-inspection, pre-licensing visit via Zoom Virtual Video Conference. LPA met with the applicant, Susana Mabilangan. Present on this visit were the licensee's fingerprint cleared assistant Romana Dangca, licensee's spouse Luis Mabilangan, licensee's 11-year-old and 2-year-old nieces who reside in the home and 2 other preschool children.

The applicant has submitted a Change of Location application for a small family childcare home license. The facility address is 402 Clauser Drive Milpitas CA 95035. The home was virtually toured to conduct a health and safety inspection. Applicant stated that the hours of operation will be from Monday to Friday 7:00 am to 6:00 pm.

The home is a four-bedroom, two bath and one-story single-family home. The applicant is renting the home since November of 2020. The home is neat, clean with heating, ventilation for safety and comfort.

The On-Limit areas are the day care playroom, online day care room (isolation room) and the hallway bathroom. LPA reminded applicant that other than wipes or things used for the children in the on limits children’s bathroom, they need to be empty of most all items (or locked up) cleaning products. The applicant understood. There are no accessible hazardous cleaning chemicals or other liquids in the on-limits area. The Off-Limit areas are the bedroom two, bedroom three, master bedroom, master bathroom, living area, kitchen area and backyard which will be inaccessible to children in care by closed and or locked doors and or a fence with visual supervision. LPA reminded the applicant that any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing. The applicant understood.

See LIC809-C for continuation - Page 2.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel Estoesta	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2021

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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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: MABILANGAN, SUSANA	FACILITY NUMBER: 435700327
	VISIT DATE: 02/01/2021

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Continuation - Page 2

Applicant has a first aid kit. The home has a fully charged 3A40BC fire extinguisher, smoke detector (tested and functioning) and a working telephone. Applicant stated that there are no firearms in the home. Wall living room AC/heater and fireplace are completely fenced.

The applicant’s Preventive Health and Safety training is completed on 07/16/2016. LPA discussed that after 07/01/2020, change of location application requires a new Preventive Health and Safety Training that includes a Lead Poisoning Prevention Training.

Applicant stated that her pediatric CPR and First Aid certificate was take on 09/16/2019. LPA advised applicant that pediatric CPR and First Aid certificate is missing. Applicant will re-submit copies of her pediatric CPR and First Aid certificate to the Regional Office.

The applicant completed the California Child Abuse Mandated Reporter Online Training for Child Care Providers (AB1207). LPA reminded the applicant that Mandated Reporter training expires every 2 years.

Applicant has ample age-appropriate toys and learning materials. LPA discussed that baby bouncers & drop-down cribs are not allowed at the day-care facility, Unusual Incidents Reports and children teacher Ratios. Applicant understood.

Applicant is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Applicant was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov

Incidental Medical Services (IMS) policy was discussed. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information 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

See LIC809-C for continuation - Page 3.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel Estoesta	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2021

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: MABILANGAN, SUSANA	FACILITY NUMBER: 435700327
	VISIT DATE: 02/01/2021

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Continuation - Page 3

Licensee missing requirements are the following;

1. Signed LIC 9151 Property Owner/Landlord Notification Family Child Care Home
2. Immunization record for TDAP and Measles, Flu vaccination or Flu vaccination declination statement.
3. Preventive Health and Safety Training that includes a Lead Poisoning Prevention Training.
4. Copy of CPR and First Aid certificate.

LPA will mail the applicant after receiving the above requirements;
1. Safe Sleep-in Child-Care
2. Lead Testing
3. Child Care Immunization Record Blank forms
4. Record and Reporting Packet
5. License

Applicant was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, and to also email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list.

License is not granted at this time. Licensee will complete the following documents within 2 weeks. LPA discussed LIC 809, applicant will mail copy for required signature and applicant will send the signed copy to the Regional Office. Exit interview conducted.

End of report.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel Estoesta	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2021

LIC809 (FAS) - (06/04)

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