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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002713
Report Date: 12/02/2022
Date Signed: 12/02/2022 02:41:20 PM

Document Has Been Signed on 12/02/2022 02:41 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:MATSUI, DANIELAFACILITY NUMBER:
384002713
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
12/02/2022
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
01:37 PM
MET WITH:Daniela MatsuiTIME COMPLETED:
02:56 PM
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On 12/2/2022, Licensing Program Analyst (LPA), Hanson Leong, made an announced case management visit to the Daniela Matsui facility. The licensee requested a departmental visit to increase capacity from eight (Small License) to fourteen children (Large License). The LPA was granted entry by the Licensee. Daniela Matsui. The LPA explained the purpose of the visit to the licensee. Guardian, the department's system for conducting background checks, has confirmed that all the individuals listed on the facility’s roster have been granted permission to work or be present in a childcare facility. The LPA observed the licensee supervising three infants and two preschool children. Children's capacity and ratio requirements were observed to be in compliance.

LPA and the licensee both performed a health and safety inspection of the facility. The house is clean and safe, with functioning smoke and carbon monoxide detectors as well as a fully charged fire extinguisher. The licensee has a First Aid Kit at their disposal that is filled, in addition to a thermometer. The fireplace in the house is enclosed by a child proof gate on all sides. The location of the residence does not include any bodies of water. The trash cans owned by the licensee have lids that fit tightly and are covered. Toys and equipment that are age-appropriate for the children who are being cared for at the home are always made available to them. The LPA reminded the licensee not to use baby walkers, bouncers, jumpers, or any other devices of a similar nature on the children while they were traveling in their vehicle.

The Licensee was reminded by the LPA that if she cares for the thirteenth and fourteenth children, who must be school-age, parent notification and landlord consent are required. The following is required to be posted in an accessible location in view of parents: Emergency Disaster Plan (LIC 610), Parent's Rights (LIC 995A), and License (once received).

The licensee won't be recommended for a Large Family Child Care Home License until the fire department approves the facility's fire clearance.


***See Page 2 for continuation***
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE: DATE: 12/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/02/2022
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: MATSUI, DANIELA
FACILITY NUMBER: 384002713
VISIT DATE: 12/02/2022
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Continued, Page 2
A copy of the report and the " Notice of Site Visit," were provided to the Licensee

An exit interview was conducted, and the report was reviewed with the Licensee, Daniela Matsui

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2022
LIC809 (FAS) - (06/04)
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