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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376100706
Report Date: 04/07/2021
Date Signed: 04/07/2021 11:20:11 AM

Document Has Been Signed on 04/07/2021 11:20 AM - 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:BELLOFATTO, ELIZABETH FAMILY CHILD CAREFACILITY NUMBER:
376100706
ADMINISTRATOR:ELIZABETH BELLOFATTOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(858) 228-6994
CITY:SAN DIEGOSTATE: CAZIP CODE:
92117
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
04/07/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Elizabeth Bellofatto, Licensee TIME COMPLETED:
11:20 AM
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Licensing Program Analyst (LPA), Jennifer Lott, conducted an announced Change of Location Licensing Inspection via Virtual Visit due to COVID-19 restrictions. LPA met with Licensee, Elizabeth Bellofatto, identified herself, and disclosed the purpose of the virtual call. The Licensee applied for a change of location with a capacity of fourteen (14). The home consists of three (3) bedrooms and three (3) bathrooms. The licensee will be using the following areas for day care: Yard #1, kids classroom/playroom, living room, dining room, kitchen, and bathroom #2. Off limit areas include: Bedroom #1, 2 &3, bathroom #1&3, yard #2. There is no garage attached or detached from the home. The Fire Marshall inspected the home on 04/06/2021 and granted the fire clearance. Business Hours are Monday through Friday 7am-5pm. An overall inspection of the facility was conducted inside and out. The inspection included, but was not limited to:

Physical Plant: The facility has a functioning carbon monoxide / smoke detectors throughout the home meeting statutory requirements. A fire extinguisher was fully charged and located in the kitchen. There is a fireplace with a locked gate surround to prevent access by children. Storage areas for poisons, detergents, cleaning solutions, medications and items which state, "keep out of reach of children" have been locked in a cupboard and are inaccessible to children. There are no bodies of water/pools on the home. Licensee, Bellofatto advised there are no firearms or ammunition stored on the premises. The home is kept clean and orderly with heating and ventilation for safety and comfort. There are no stairs in the home. The home provides safe toys, play equipment and materials.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Jennifer Lott
LICENSING EVALUATOR SIGNATURE: DATE: 04/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/07/2021
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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: BELLOFATTO, ELIZABETH FAMILY CHILD CARE
FACILITY NUMBER: 376100706
VISIT DATE: 04/07/2021
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Administration: All individuals subject to a criminal record review have obtained a clearance and/or an exemption prior working, residing or volunteering in the home. The licensee has completed training on preventive health practices including pediatric CPR and First Aid. Staff immunizations were reviewed and are in compliance. There is a working telephone and email address.

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 (US DOJ) 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

No deficiencies were noted at this time. A license fourteen (14) children will be granted upon final file review. Applicant agrees to comply with all regulations and laws governing Family Child Care Homes.

Additional Technical Assistance was provided and noted on the attached Advisory Note – Technical Assistance.

An exit interview was conducted with Licensee, Bellofatto. A copy of this report, Appeal and Licensee Rights (LIC 9058) as well as Notice of Site Visit Form (LIC 9213) have been provided via email. An email read receipt confirms the documents were received. Licensee also acknowledges that the LIC 9213 is required to be posted for 30 days.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Jennifer Lott
LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2021
LIC809 (FAS) - (06/04)
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