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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004320
Report Date: 04/13/2021
Date Signed: 04/13/2021 02:27:11 PM

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:MORA PLATERO, INES DEL CARMENFACILITY NUMBER:
384004320
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
04/13/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Applicant, Ines Del Carmen Mora PlateroTIME COMPLETED:
10:00 AM
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Licensing Program Manager (LPM), Cindy Interiano, virtually met with Spanish Speaking Applicant, Ines Del Carmen Mora Platero, via a Tele-Inspection. Purpose of the inspection was explained. Applicant lead LPM on a virtual inspection of the facility indoors for Health and Safety hazards. Applicant rents home, which is a 2 bedroom, 1 bathroom unit on the lower level of a two story duplex. Applicant lives with Husband, Adult Brother, and a minor child. Daycare areas are: Living Room and Bathroom #1. OFF limit areas: Driveway, Garage, Front yard, Back yard, Kitchen (pass through only to bathroom #1), Bedroom #1, and Bedroom #2. All off limit areas, including all closets, are properly barricaded. First Aid Kit is fully stocked and accessible. Home has a fully charged fire extinguisher, and a functioning smoke and carbon monoxide detector. All harmful and sharp objects are made inaccessible from children in care. Applicant states there are no guns or weapons in the home. The home is clean and orderly with sufficient lighting and ventilation. Daycare area has no bodies of water or chimney. Applicant states she will conduct an emergency drill once every six months and log drills. Applicant’s CPR expires in 01/2022. Home has age appropriate toys and equipment available for the children in care. Applicant states discipline policy is redirection. Postings will be posted near main door of the Daycare area. Applicant is reminded of NO walker, exersaucers, jumpers, bouncers and any similar items to be used for children in care and shall be made inaccessible. Applicant is advised all Adults, 18 years and older living in the home, helper, or assistant must have finger print clearance and must be associated to the facility by submitting an LIC 9182 with copy of CDL or Ca. ID prior to having any contact with children in care failure to do so could result in an immediate civil penalty of $100.00 each day.

Applicant was informed that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.

See Page 2. . .
SUPERVISOR'S NAME: Suzanne Roman-ClarkTELEPHONE: (650) 266-8823
LICENSING EVALUATOR NAME: Cindy InterianoTELEPHONE: (650) 266-8864
LICENSING EVALUATOR SIGNATURE:

DATE: 04/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2021
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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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: MORA PLATERO, INES DEL CARMEN
FACILITY NUMBER: 384004320
VISIT DATE: 04/13/2021
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>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: http://www.ada.gov/childqanda.htm
>Applicant was reminded about the Provider Information Notices (PINs) on the CCLD website.
>A copy of A Child Care Provider’s Guide to Safe Sheet will be provided to the Applicant.
>Applicant was advised of the new Lead Bill (effective 01/01/19), requiring Facilities to distribute a two-page flyer to Guardians with information on lead poisoning facts. Flyer will be provided to the Applicant.
>Applicant was reminded of Mandated Reporter Training available on CCLD website or at www.mandatedreporterca.com and renewal is every 2 years.

Applicant was advised that a packet of information (in English and Spanish) will be sent via mail, which will have Records to be Maintained in the facility for all children in care. Mandatory Posting Requirements: License, Emergency Disaster Plan, and Notification of Parent's Rights Poster.

During the tele-inspection, LPM provided Technical Assistance for Covid-19 guidelines, including Social Distancing, proper use of PPE equipment, and cleaning / disinfecting / sanitizing of commonly used areas/items.

Capacity limits of a Small Family Child Care License has been reviewed.

Applicant were advised that a follow-up inspection will be conducted in the future.

All Adults have criminal record clearance. Applicant’s Husband has an approved Exemption and Husband and Applicant understand the conditions of the exemption.

A Small Family Child Care License is approved and will be effective as of today, 04/13/2021.

>This report will be emailed to the Applicant. This report must be available in the facility for public review. Any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.cdss.ca.gov
SUPERVISOR'S NAME: Suzanne Roman-ClarkTELEPHONE: (650) 266-8823
LICENSING EVALUATOR NAME: Cindy InterianoTELEPHONE: (650) 266-8864
LICENSING EVALUATOR SIGNATURE:

DATE: 04/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2021
LIC809 (FAS) - (06/04)
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