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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005614
Report Date: 04/20/2022
Date Signed: 04/20/2022 01:01:29 PM

Document Has Been Signed on 04/20/2022 01:01 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:DUARTE, MARIANA P.FACILITY NUMBER:
214005614
ADMINISTRATOR:DUARTE, MARIANA P.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 225-5982
CITY:MILL VALLEYSTATE: CAZIP CODE:
94941
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
04/20/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Applicant, Mariana DuarteTIME COMPLETED:
01:15 PM
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On April 20,2022 at 11:45am Licensing Program Analyst (LPA) Kassandra Medrano met with applicant, Mariana Duarte. Applicant lives in Single Family, Two story home, with husband. Home has 5 bedrooms and 3 bath. Hours of operation will be Monday to Friday 7:30AM to 5PM. Childcare will be provided in areas: Entire down stairs, lower level of yard, Off limit areas: kitchenette in lower level, Upstairs portion of house, front yard, upper levels of back yard. LPA inspected the entire home with the applicant for health and safety hazards. The house has proper temperature and ventilation. Home is currently under construction and has recently been advised by fire to make corrections prior to fire clearance. This is a relocation, and applicant is still operating at licensed facility. Applicant does not have facility set up with age appropriate toys because she is still operating at other facility. There is not a fireplace in day-care area and is properly barricaded. LPA reminded applicant not to place toys or things in front of air vents. The house has a working telephone, fully charged fire extinguisher, smoke detector, and carbon monoxide detector. Applicant has first aid supplies available. Applicant states that there are no pets in the home. As per the applicant, there are no firearms or weapons in the home. Applicant was informed that time outs cannot be any longer than one minute per age of the child and cannot exceed five minutes. Applicant states that she will only be using communication and redirection for children as forms discipline. LPA informed the applicant that emergency drills will be conducted at least once every six months and drills must be logged. Applicant's First Aid/CPR certificate is current. Applicant has been made aware that they need required postings in the home. LPA discussed facility ratios and capacity's with the applicant. The applicant was reminded there are no walkers, exersaucers, jumpers, bouncers and any similar items to be used for children in care and shall be made inaccessible. Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Kassandra Medrano
LICENSING EVALUATOR SIGNATURE: DATE: 04/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/20/2022
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 2
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: DUARTE, MARIANA P.
FACILITY NUMBER: 214005614
VISIT DATE: 04/20/2022
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 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 reviewed with applicant the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted Entrance Checklist was provided to the applicant. LPA discussed the safe sleep regulations with applicant 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 applicant 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. APPLICANT KNOWS FACILITY PLANS TO PROVIDE IMS: This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. 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

PRIOR TO LICENSURE APPLICANT MUST COMPLETE THE FOLLOWING:

1. RECEIVE FIRE CLEARANCE


2. CLEAN CHILD CARE AREAS
3. INSPECTION OF YARD WILL BE NEEDED
To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with the applicant, Mariana.

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Kassandra Medrano
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2022
LIC809 (FAS) - (06/04)
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