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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005361
Report Date: 06/29/2022
Date Signed: 06/29/2022 12:32:04 PM

Document Has Been Signed on 06/29/2022 12:32 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:SOARES, KARINA M.FACILITY NUMBER:
214005361
ADMINISTRATOR:SOARES, KARINA M.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 701-3679
CITY:SAN RAFAELSTATE: CAZIP CODE:
94903
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
06/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Karina SoaresTIME COMPLETED:
12:30 PM
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On 6/29/2022, Licensing Program Analysts (LPAs), Hanson Leong and Nathan Garcia, made an unannounced annual visit to the Karina Soares facility. LPAs were granted entry by the licensee, Karina Soares. LPAs explained the purpose of the visit to the licensee. All the facility's staff members have had their criminal background checks cleared by Guardian. LPAs observed the licensee and her helper supervising four infants and seven preschool children. From Monday to Friday, the hours of operation are 8:00 a.m. to 4:30 p.m.

The daycare areas include the family room next to the backyard, the kitchen/dining area, the children's bathroom next to the family room (converted to a playroom) and the backyard. The off-limit areas include the dining room on the left side of the entrance, the three bedrooms and the bathroom in the main house. When a child exhibits symptom of illness, the Licensee will separate the child while contacting the parent to arrange for the child's pick-up

LPAs and the Licensee thoroughly checked the daycare areas for potential health and safety hazards. The daycare is outfitted with age-appropriate toys and equipment. The facility is well-lit, well ventilated, and free of defects or conditions that endanger children in care. The daycare is outfitted with a smoke detector, a carbon monoxide detector, and a fully charged fire extinguisher. All the electrical outlets and trash cans are covered. Children have access to first-aid supplies. Cleaning products, detergents, and other items that could endanger children are kept out of reach of children. LPAs observed no walkers, bouncers, or other similar items. According to the Licensee, there are no firearms or weapons on the premises. LPAs observed that there were no pools, spas, or other bodies of water in the facility.

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SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE: DATE: 06/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/29/2022
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 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: SOARES, KARINA M.
FACILITY NUMBER: 214005361
VISIT DATE: 06/29/2022
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LPAs observed that the licensee had posted all the required forms, including the facility License, Notification of Parental Rights, Earthquake Preparedness Checklist, and Notification of Personal Rights. The licensee is aware that smoking is not permitted in family childcare facility.

LPAs reviewed the records of ten children. All the children have an emergency information card in their file, which includes their full name, phone number, and the location of a parent or other responsible adult who can be contacted in an emergency. The children's file included parental consent for the Licensee or registrant to consent to emergency medical care, as well as the child's physician's name and phone number. LPAs observed that the LIC 995a were missing from six children. As form of compliance, LPAs issued the licensee a technical violation for missing the LIC 995A from the children’s’ files.

LPAs reviewed the records of the licensee and her helper. Both kept up with her Pediatric First Aid and CPR certifications. LPA also met with the licensee to go over supervision and capacity expectations/requirements. Although the Licensee does not transport children, she understands that children should never be left unattended in vehicles.

Every six months, fire and earthquake drills are held and documented.



Licensee was reminded that all adults 18 and over living or working in the home, 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.

LPAs discussed the safe sleep regulations with the Licensee and discussed the Child Care Licensing Safe Sleep webpage https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed the 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.

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SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2022
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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: SOARES, KARINA M.
FACILITY NUMBER: 214005361
VISIT DATE: 06/29/2022
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Incidental Medical Services (IMS) policy was discussed. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes 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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

LPAs reminded the licensee as of January 1, 2018, all staff must complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

LPAs encouraged the Licensee to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. The Licensee can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

A copy of this report, and the “Notice of Site Visit,” were given to the licensee.

A Notice of Site Visit must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

An exit interview was conducted, and the report was reviewed with the licensee, Karina Soares

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2022
LIC809 (FAS) - (06/04)
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