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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384003071
Report Date: 06/27/2022
Date Signed: 06/27/2022 11:42:01 AM

Document Has Been Signed on 06/27/2022 11:42 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:GARCIA, SANDRA P.FACILITY NUMBER:
384003071
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
06/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Sandra GarciaTIME COMPLETED:
12:00 PM
NARRATIVE
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On June 27, 2022, at 9:15AM., Licensing Program Analyst (LPA), Luis J. Gomez met with Licensee, Sandra Garcia. Purpose of the inspection was explained and was for an unannounced; Annual/ Random inspection. Present was the licensee and caring for four children. All children present were infant age. Licensee’s home is a one bedroom, one bathroom, one level unit. Days and hours of operation are Monday- Friday, 8:00 AM. to 5:30 PM. Day-care Area: Living room (Playroom), Bathroom Off-limit Area: Kitchen and Bedroom #1. LPA inspected home with licensee for health and safety hazards.

At 9:30AM, the following was observed: day-care was clean, orderly, and with age appropriate playthings available for the children. Furniture inspected were in good repair and free if any sharp corners. Playroom had child size table and chairs. Children baskets were in facility closet fir added storage. Floors and surfaces were covered with soft padding/ carpet to cushion potential falls. Playroom was equipped with a diaper changing table. For napping services, play pen and several mats were stored in playroom. Mattress inspected was the proper size with tight-fitting sheet installed. LPA reminded licensee to ensure facility has least one crib available for each infant in care. Bathroom #1 was observed clean with supplies available for hand washing. Bathroom fixtures tested were in operating condition. Off-limit areas were made inaccessible with child safety gates. Outlets and trash bins had coverings. Items which could pose a danger including; detergents, compounds, wipes and spray bottles, were stored in the off-limit area. Facility was the proper temperature, with adequate ventilation and lighting. Home had functioning cell phone, smoke detector/ carbon monoxide detector combo and one, fully charged, fire extinguisher (2A:10BC). LPA was unable to test detector during inspection. During inspection, Advisory Note: Technical Assistance (LIC9102TA) was issued.

Home did not have any swimming pools, spas, hot tubs, fishponds or other bodies of water. Per licensee, home does not have any guns for weapons. Isolation of an ill child is the hallway. (REFER TO 809C FOR CONT.)

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 06/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/27/2022
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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Document Has Been Signed on 06/27/2022 11:42 AM - It Cannot Be Edited


Created By: Luis Gomez On 06/27/2022 at 10:31 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: GARCIA, SANDRA P.
FACILITY NUMBER: 384003071

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/27/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, LPA confirmed licensee's mandated reporter training certification had expired. This poses a potential health and safety risk to children in care.
POC Due Date: 07/06/2022
Plan of Correction
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Licensee will submitted updated mandated reporter training certification (AB1207) to the Department by the due date: 7/6/2022. Licensee will submit proof of correction via email.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Cindy Interiano
LICENSING EVALUATOR NAME:Luis Gomez
LICENSING EVALUATOR SIGNATURE:
DATE: 06/27/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/27/2022


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: GARCIA, SANDRA P.
FACILITY NUMBER: 384003071
VISIT DATE: 06/27/2022
NARRATIVE
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At 9:55AM., LPA reviewed the facility and children’s records. Children's records were reviewed and included: (LIC700) Identification of Emergency Information; (LIC624) Consent for Medical Treatment; (LIC9151) Notification of Additional Children in Care and (LIC995A); Notification of Parent’s Right’s; and Immunization Record.

At 10:00A.M., Based on interview and record review, LPA confirmed licensee's mandated reporter training certification had expired.

At 10:05AM., Based on record review and interview, LPA confirmed children’s files missing the 'Individual Infant Sleeping Plan' (LIC9224) for qualifying infant's in care. During inspection Advisory Note: Technical Violation (LIC9102TV) was issued.

At 10:10AM., Based on record review and interview, LPA confirmed licensee is not maintaining documentation for each 15-minute check for napping infants in care. During inspection, Advisory Note: Technical Violation (LIC9102TV) was issued,

Licensee's Cardiopulmonary Resuscitation (CPR)/ First Aid Certification was current, expiring on 1/22/2024.

Emergency disaster drill are conducted every six months, with last drill completed on 5/27/2022. LPA reminded licensee to document all emergency disaster drills.

LPA observed required posting, including: Childcare License and Notification of Parent’s Rights (LIC995A) in hallway. Children's Roster (LIC9040) was review during inspection.

Per licensees, she provides lunch and snack for children in care. LPA asked licensee to ensure all children’s food containers brought to facility by families are properly labelled.


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

DATE: 06/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2022
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: GARCIA, SANDRA P.
FACILITY NUMBER: 384003071
VISIT DATE: 06/27/2022
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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.

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, deficiencies were observed in areas evaluated, according to California Title 22, Health and Safety Code of Regulations. Exit interview and plan of correction was discussed with Licensee, Sandra Garcia 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. Website

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2022
LIC809 (FAS) - (06/04)
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