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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004141
Report Date: 07/08/2021
Date Signed: 07/08/2021 12:09:35 PM

Document Has Been Signed on 07/08/2021 12:09 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:VASQUEZ, CLAUDIA MFACILITY NUMBER:
384004141
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
07/08/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Claudia M VasquezTIME COMPLETED:
12:30 PM
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Licensing Program Analysts, LPA Yee, conducted an annual random inspection today. LPAs and Ms. Vasquez toured the entire home. The facility consists of 2 bedrooms, one bath, living room, dining room, kitchen, storage room, 2 car garage, one studio room located in the lower level, and backyard. Current residents are Ms. Vasquez and her daughter only. The lease agreement is on file. LPA informed her if she hires a new helper, the helper needs to have fingerprint clearance prior to having any contact with children in care. She said she understands. Ms. Vasquez has current CPR, 1st Aid which expires 6/2022. Child Abuse Mandated Reporter Training, AB1207 is current until 7/21/2022. A Child Care Provider's Guide to Safe Sleep" information wDaycare area (upper level): daycare room #1, daycare room #2, bathroom, kitchen, and backyard. The remaining areas of the house are off-limit. The home has a smoke alarm, carbon monoxide detector, and fully charged fire extinguisher. The home has age-appropriate toys and equipment available for the children in care. The facility personnel summary was reviewed with Ms. Vaszuez. She said her helper Yessica no longer working for her, she requested to remove her from the list. Safe Sleep practice was discussed and LIC9227 was provided. The facility provides snacks and lunches. Children's files were reviewed. The capacity worksheet was provided. This report was emailed to the licensee.


website: www.ccld.ca.gov. Title 22, Div 12, Chp3
Desk duty: Monday-Friday, 650-266-8800
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jennifer Yee
LICENSING EVALUATOR SIGNATURE: DATE: 07/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/08/2021
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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