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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384000735
Report Date: 12/14/2022
Date Signed: 12/14/2022 11:07:30 AM

Document Has Been Signed on 12/14/2022 11:07 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:VANEGAS, MIRIAMFACILITY NUMBER:
384000735
ADMINISTRATOR:VANEGAS, MIRIAMFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 285-4067
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 2DATE:
12/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Miriam VanegasTIME COMPLETED:
11:20 PM
NARRATIVE
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On 12/14/2022 at 8:55AM., Licensing Program Analyst (LPA), Luis J. Gomez met with Licensee, Miriam Vanegas. Purpose of the inspection was explained and was for an Unannounced; Annual Random inspection. Present was the licensee caring for two children (1 preschool age, 1 infant age). Adults have criminal record clearances on file. Licensee’s home is a two bedroom, two bathroom, one level unit. Days and hours of operation are Monday- Friday, 8:00AM- 5:00PM. Daycare areas are: Living room (Playroom) and Bathroom. Off Limit areas are: Bedroom #1; Bedroom #2; Bathroom #2; and Kitchen. LPA inspected home with licensee for health and safety hazards.

At 9:05AM., the following was observed: Facility was clean, orderly, with age appropriate playthings available for the children. Floor and ground surfaces are clear of obstructions. Playroom windows and fireplace have been made inaccessible. Furnishings, books, puzzles, and supplies inspected were in proper repair. Furniture inspected was free of loose parts or sharp corners. Individual cubbies are available for children belongings. For napping services, LPA observed mats stored in facility playroom. LPA observed play pen (with tight-fitting sheet) available for infant in care. Per licensee napping supplies are washed weekly. Bathroom#1 was maintained clean with supplies for child hand-washing. Fixtures tested were in operating condition. Outlets and trash bins have been covered. Facility was a comfortable temperature with sufficient lighting and ventilation. Detergents; cleaning compounds; toxins and items which pose a hazard, have been made inaccessible. Home had functioning telephone; smoke/ carbon monoxide combination detector; and fire extinguisher, 2A:10BC.

Home does not any pools, fishponds, or accessible bodies of water.


(REFER TO 809C, FOR CONT)
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 12/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/14/2022
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: VANEGAS, MIRIAM
FACILITY NUMBER: 384000735
VISIT DATE: 12/14/2022
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At 9:35AM, LPA reviewed facility and children’s records. Children files were reviewed and included the: Identification of Emergency Information (LIC700); Consent for Medical Treatment (LIC627); Immunization Records; Notification of Parent’s Rights (LIC995); Infant Sleeping Plan (LIC9227) and Admissions Agreement.

Licensee is maintaining documentation for each 15- minute check for napping infants.



Licensee was reminded to renew required 'Mandated Reporter Training' (AB1207) Certificate every two years. Licensee’s Cardiopulmonary Resuscitation (CPR)/ First Aid certification is current, expiring: 06/2024.

Licensee is conducting required disaster drills, with last drill completed, 6/20/2022.
Licensee was reminded to log all disaster drill conducted.

Required posting are posted in entry way. Visible postings include the Childcare License, Notification Parent’s Rights (PUB379), and Emergency Disaster Plan (LIC610A).

Per licensee, isolation of ill children is hallway. Children’s Roster (LIC9040) was updated during inspection.



Per licensee, she provides all food services for children in care. LPA reminded licensee to ensure children’s food containers brought by families are labeled with child’s name. Per licensee, home does not have any firearms.

Licensee was reminded that all adults 18 years and over, living or working in the home, including employee and volunteers, must obtain criminal 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.


(REFER TO 809C, FOR CONT.)
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2022
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: VANEGAS, MIRIAM
FACILITY NUMBER: 384000735
VISIT DATE: 12/14/2022
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LPA discussed the safe sleep regulations with licensee and discussed Child Care Licensing Safe Sleep Web page at:https://www.cdss.ca.gov/inforesource/child-care-licesning/public-information-and-resources/safe-sleep as an additional resource. LPA informed licensee of the importance of checking for recalled infant devices on United States consumer Product Safety Commission (CPSC) website at http://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tool, please send them to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesource/community-care-licensing/inspection-process.

Based on today's inspection, no deficiencies were observed in areas evaluated according to California Title 22, Health and Safety Code of Regulations. Exit interview and report was discussed with Licensee, Miriam Vanegas, and signature of this form acknowledges receipt of these documents.



Notice of Site Visit was provided and must be posted for 30 days.

This report must be available in the facility for public review. Licensee was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766.
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2022
LIC809 (FAS) - (06/04)
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