384000813-8-18-2022-05-CC-CQUO-CHEN69-20220818101046

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384000813
Report Date: 08/18/2022
Date Signed: 08/18/2022 10:10:54 AM

Document Has Been Signed on 08/18/2022 10:10 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:	GUERIN, DENISE MARIE		FACILITY NUMBER:	384000813
ADMINISTRATOR:	GUERIN, DENISE MARIE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 821-7705
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94131
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 10	CENSUS: 6	DATE:	08/18/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Denise Guerin		TIME COMPLETED:	10:30 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On August 18, 2022 at approximately 8:15am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, annual inspection. LPA met with Licensee, Denise Guerin, and explained the purpose of the inspection. Present during LPA's visit included licensee, licensee's two helpers (H1 and H2), and 6 enrolled children (2 infants and 4 preschool age). Licensee is operating within capacity limits and ratio during LPA's visit. All adults living and/or working in the home have a criminal record clearance on file. Hours of operation are Monday to Thursday from 8:00am to 5:00pm. Licensee lives in the multi-level home that consists of 3 bedrooms, 2 bathrooms, living room, kitchen and dining room. The DAY CARE AREAS are living room, play room, bathroom #1 (separate rooms for toilet and sink), kitchen and backyard. The OFF LIMIT AREAS are office, bedroom #1, dining room and entire upstairs level of home. Off limit areas are properly barricaded with child safety gates and/or locked doors. At approximately 8:30am, LPA toured day care areas of home with Licensee. LPA observed home to be in good repair with proper temperature and ventilation. There were a variety of age appropriate toys and equipment in the home which were in good condition. LPA observed cleaning supplies, poisons and other chemicals to be stored inaccessible to children in home's high shelves and/or locked behind child safety locked cabinets. Home contains a fireplace that is properly barricaded and made inaccessible to children in care. LPA observed a working smoke and carbon monoxide detector, fully charged fire extinguisher, fully stocked first aide kit and working phone on site. Phone number listed for licensee is current. Per licensee, there are no weapons or firearms in the home. LPA did not observe any pools, spas or bodies of water on the property. The backyard is enclosed with an least 5ft high fence. Backyard is equipped with appropriate outdoor toys and equipment that are in good working condition. Stairs in backyard are properly barricaded with child safety gates. LPA observed backyard is also equipped with emergency supplies and materials. (Continue Report on Page 2...)

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2022

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: GUERIN, DENISE MARIE	FACILITY NUMBER: 384000813
	VISIT DATE: 08/18/2022

NARRATIVE

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LPA reviewed ten children’s records which were complete. Children’s files have a record of emergency identification information on file. LPA reviewed Licensee, H1 and H2's files which were also complete. Licensee, H1 and H2 all have a valid, current CPR certificate. Licensee's CPR/First Aid certificate will expire 08/2024. Licensee, H1 and H2 all have records of required immunizations and valid Mandated Reporter certificates.

Emergency drills are conducted at least once every six months. Last emergency drill was conducted 08/2022. Licensee also implements safe sleep log documentation for all enrolled children while in care. Safe sleep log documentation notates the time children fall asleep and 10 minute time intervals of when children are last checked on.

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: www.ada.gov/childqanda.htm.

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 tools, please send them by email 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/inforesources/community-care-licensing/process

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.

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SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2022

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: GUERIN, DENISE MARIE	FACILITY NUMBER: 384000813
	VISIT DATE: 08/18/2022

NARRATIVE

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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.

No deficiencies were cited today under CCR, Title 22, Div. 12, Chapt. 1.

A notice of site visit was given and must remain posted for 30 days.

An exit interview conducted and report was reviewed with the licensee, Denise Guerin.

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2022

LIC809 (FAS) - (06/04)

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