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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444415772
Report Date: 06/12/2019
Date Signed: 06/12/2019 11:05:55 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:ANAYA, MARIAFACILITY NUMBER:
444415772
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 4DATE:
06/12/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:41 AM
MET WITH:Maria AnayaTIME COMPLETED:
11:15 AM
NARRATIVE
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Licensing Program Analyst (LPA) Mahvash Behbood conducted an unannounced Annual Random visit. The purpose of today’s visit explained to licensee. Present also were- 4 children. Hours of operation are Monday - Friday, 6 am to 6 pm. She is contracted with Migrant Head Start. The Licensee, her sister, her brother in law, their 2 minor children, her father, her step mother and her adult brother live in the facility. All adults or other individuals who require caregiver background checks have received criminal record and child abuse index clearance or exemptions. Licensee's CPR and First Aid are current and expire in May of 2021. Licensee has proof of immunization in her file. as well as California Mandated Reporter Training. Licensee is aware that the Mandated Training must be completed every 2 years. LPA toured the indoor and outdoor areas of the home during today's visit. LPA reviewed a current Child Care Facility Roster and Fire/Disaster Drill Log during today's visit. The Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children. The home is clean, orderly, and safe for the day care children. LPA observed a wall heaters in the day care area, the heater is securely gated and inaccessible to the children. Off limit areas in the home are as follows: Entire house except the day care area. She has a fenced designated area for the children to play the rest of the back yard is off limit.

LPA observed a fully charged 2A10BC fire extinguisher, working smoke/carbon monoxide detectors, and no bodies of water. The Licensee states that she does not have any weapons in the home. All detergents, cleaning compounds, poisons, medications, are out of reach and inaccessible to children. his facility provides Incidental Medical Services (IMS). LPA reviewed storage of medication and equipment /supplies, and reviewed children’s, personnel and administrative records.

Effect of lead exposure poster was provided to licensee and she agreed to share the information with parents.

No citation was issued during today's visit.

SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Mahvash BehboodTELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2019
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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