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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004090
Report Date: 01/13/2022
Date Signed: 01/13/2022 05:25:02 PM

Document Has Been Signed on 01/13/2022 05:25 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:LAMA, NADIA V.FACILITY NUMBER:
384004090
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
01/13/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
03:10 PM
MET WITH:Licensee, Nadia LamaTIME COMPLETED:
05:30 PM
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On 1/13/2022 at 3:10P.M., Licensing Program Analyst (LPA), Luis J. Gomez met with Licensee, Nadia Lama. Purpose of inspection was explained and was for an unannounced, Case Management inspection for increase in capacity. Present was licensee and caring for three children. All children present were infant age. Licensee’s home is a three bedroom, two bathroom, three level house. Days and Hours of operations are: Monday – Friday, 8:00 A.M., to 5:00 P.M. Day-care Areas: Top Level Bedroom #1, Bathroom #1, Living Room Area (Playroom) Ground level: Backyard Area Off-limit Area: Top Level: Kitchen, Bedroom #2, Living Room #2, Middle Level: Bedroom #3, Bathroom #2 and Ground level: Garage. Home was inspected with the licensee for health and safety hazards.

At 3:15P.M., LPA observed the following: Day-care was clean and orderly. Playroom was equipped with age appropriate toys, blocks and games for the children. All playthings inspected were in good repair. Licensee has child size table and chairs. Fireplace and the off-limit area had been properly barricaded. For napping services, LPA observed several infant playpens located in bedroom #1. Bathroom #1, located in hallway, had adequate supplies for the children. Day-care has a functioning cell phone, smoke /carbon monoxide detector combo, and a fully charged fire extinguisher (2A:40BC), located in the hallway.

At 3:40P.M., LPA inspected outdoor play yard. Play yard was completely enclosed with tall fencing. Home does not have a swimming pool, spa, hot tub, fish pond or any other bodies of water.

At 3:50P.M., Based on observations, LPA confirmed broken child's bench, located in the outdoor play yard. Technical Assistance (9102TA) was issued during inspection. (REFER TO 809-C FOR CONT.)

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 01/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/13/2022
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: LAMA, NADIA V.
FACILITY NUMBER: 384004090
VISIT DATE: 01/13/2022
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Licensees CPR/ 1st aid certifications were current, expiring: 02/2023. Children’s roster was updated during inspection. LPA reminded licensee to renew mandated reporter training certificate once every two years. LPA observed required forms visibly posted in entry way. Posted forms including the Facility License, Emergency Disaster Plan and the Parent's Rights. Per licensee, facility will provides all daily snacks and meals. LPA reminded licensee to label all children food containers. Per licensee, there are no guns or weapons in the home.

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 Webpage 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

During inspection, large license capacity limits were reviewed with both licensees. Licensees were reminded that when operating at a large capacity, there must be at least one helper present.

Prior to recommendation for Increase in Capacity, licensee must submit the following documents:

-Submit approved Fire Clearance Request (STD850)

-Updated Preventative Health and Safety Practices, with Lead Poisoning Prevention Course

-Updated Flu declaration (2021)

-Updated Mandated Reporter Training Certification

-COVID-19 Self- Assessment

-Prelicensing Readiness Guide (LIC9

This report must be available in the facility for public review. Notice of site visit was observed being posted. Licensee was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.cdss.ca.gov

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

DATE: 01/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2022
LIC809 (FAS) - (06/04)
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