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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005618
Report Date: 07/01/2022
Date Signed: 07/01/2022 01:29:52 PM

Document Has Been Signed on 07/01/2022 01:29 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:SILVA, MARIANNE C.FACILITY NUMBER:
214005618
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
07/01/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Applicant, Marianne SilvaTIME COMPLETED:
01:40 PM
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On July 1st,2022 at 12:45pm Licensing Program Analyst (LPA) Kassandra Medrano met with applicant, Marianne Silva. Applicant lives in a two story home, with husband. Home has 3 bedrooms and 2 bath. Hours of operation will be Monday to Friday 7:30AM to 5:30PM. Childcare will be provided in areas: Living room, dining room, bathroom #1 and part of backyard that has been sectioned off. Off limit areas: Kitchen, Bedrooms 1-3, garage, upper loft, and front yard, parts of backyard that have been fenced off. LPA inspected the entire home with the applicant for health and safety hazards. The house has proper temperature and ventilation. All toxic or dangerous materials are stored in cabinets with child protective locks installed making them inaccessible. There is in daycare area and is properly barricaded. 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 is a pet in home one cat, vaccinations are current. There are a variety of age appropriate toys available. 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 and expires 4/2024. 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: 07/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/01/2022
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: SILVA, MARIANNE C.
FACILITY NUMBER: 214005618
VISIT DATE: 07/01/2022
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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 WILL WAIT UNTIL FACILITY OPENS TO DETERMINE IMS NEEDS: Incidental Medical Services (IMS) policy was discussed. For IMS information, see PIN 22-02-CCP. 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 Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. 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

Small Family Child Care Home License is approved and will be effective as of today, 07/01/2022.



Exit interview conducted and report was reviewed with the applicant, Marianne Silva.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Kassandra Medrano
LICENSING EVALUATOR SIGNATURE:

DATE: 07/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2022
LIC809 (FAS) - (06/04)
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