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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005464
Report Date: 09/17/2021
Date Signed: 09/17/2021 03:22:00 PM

Document Has Been Signed on 09/17/2021 03:22 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:SILVEIRA,JESSICA N. & SILVEIRA,PATRICIA N.FACILITY NUMBER:
214005464
ADMINISTRATOR:SILVEIRA,JESSICA N.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 301-0110
CITY:SAN RAFAELSTATE: CAZIP CODE:
94903
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 7DATE:
09/17/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Jessica SilveiraTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA), Farhan Bashir-Tariq arrived at the facility above unannounced to conduct a required one-year inspection and met with Licensee, Jessica Silveira. Co- Licensee, Patricia was off from work today and not present in home at time of inspection. Purpose of inspection was explained. There were seven children present today with Licensee, Jessica and a helper, Iara Ribierodelima. All adults living or working in the home have fingerprints clearance on file. Licensee is operating within the capacity and ratio limits as of today 9/17/21. Hours of operation are: M-F, 7:30 AM - 5:30 PM. Licensee provides breakfast, lunch and two snacks. Licensee is part of the food program. This is a three bedroom and two-bathroom single family home. Day Care areas: Living room, Bathroom #1, Bedroom #2 & #3 (napping only) and Backyard. Off limit areas: Bedroom #1 Kitchen, Bathroom #2 (located in garage) and Garage.

LPA and Licensee inspected the entire day care area for health and safety hazards. All off limit areas were properly barricaded and made inaccessible to the children in care. Licensee states that there is no pool, spa or any other body of water in the home. Licensee states, there are no weapons or firearms in the home. Licensee states, there is a small dog in the home. The house is in good repair and free of hazards with proper temperature and ventilation. There is a carbon monoxide detector, a smoke detector, a fully charged fire extinguisher and a working telephone available in the home. There is a First Aid kit available in the home. LPA observed that there were variety of age appropriate toys, books, arts, puzzles and other learning materials available for children in care. LPA inspected the back yard as well. Back yard was fully fenced all around. Artificial grass was installed under playing structures to prevent any falls or injuries. LPA observed that facility was complying to COVID-19 restrictions. Staff was wearing masks and posters for COVID-19 were observed to be posted. Licensees Patricia, Jessica and helper, Iara all have valid First Aid and CPR cards issued on 2/24/21, 3/19/21 and 2/1/20 respectively. CPR cards are valid for two years from the date of issue. Discipline policy is communication and redirection. LPA reminded Licensee to conduct the fire or emergency drills at least once every six months and drills must be logged. Per Licensee’s log, last drill was conducted in June 2021. LPA reviewed facility records including 6 children's files and staff's files. Children's files were current and complete. LPA reviewed the identification and emergency information form for every child for proper names and numbers filled.


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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Farhan Bashir-Tariq
LICENSING EVALUATOR SIGNATURE: DATE: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/17/2021
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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: SILVEIRA,JESSICA N. & SILVEIRA,PATRICIA N.
FACILITY NUMBER: 214005464
VISIT DATE: 09/17/2021
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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm

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 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. LPA reminded Licensee , as of January 1, 2018, all staff is required to complete Mandated Child Abuse Reporter Training (AB1207) every two years. The training can be obtained online at www.mandatedreporterca.com. LPA reviewed that certificates were present for both licensees and a helper.


> No deficiencies were cited today under Title 22 Division 12 of the California Code of Regulations.

An exit interview was conducted. This report and rights to comment and appeal were discussed with Licensee. This report must be available in the facility for public review. Notice of site visit shall be posted for 30 days from today's visit. Licensee was advised for any additional questions to call Office, M-F, 8AM-5PM at 650-266-8800. For Rules and Regulations, visit the Website: www.cdss.ca.gov

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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Farhan Bashir-Tariq
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021
LIC809 (FAS) - (06/04)
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