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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004356
Report Date: 12/02/2022
Date Signed: 12/02/2022 11:07:30 AM

Document Has Been Signed on 12/02/2022 11:07 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:DIAS, ANA PAULAFACILITY NUMBER:
384004356
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 6TOTAL ENROLLED CHILDREN: 6CENSUS: 3DATE:
12/02/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Ana Paula DiasTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Yee conducted an Unannounced Required - 1 Year Visit to this family child care home and met with the Licensee Ana Paula Dias, and 3 children (one is her child). The purpose of the visit was explained. The facility personnel summary report was reviewed with Ana Paula and she said it is current. The resident at this facility are Ana Paula, her husband, her nephew, and their 9-year-old daughter. The facility operation hours are Monday - Friday, 8:30 am - 5:00 pm.

Daycare areas are bedroom #3, the hallway bathroom, and the deck. The remaining areas of the home are off-limits. Licensee’s CPR and 1st aid certificate is current and will expire on 06/2024.

LPA observed the home is clean orderly and properly ventilated. LPA also observed a 2A10BC Fire extinguisher, operable smoke detectors, and carbon monoxide. There are no bodies of water in the home. Electrical outlets have child protective covers in place making them inaccessible to children. Chemicals, detergents, cleaning compounds, medications, and other items of this nature are made inaccessible to children. Kitchen/Bathroom cabinets/drawers have child protective locks in place making all sharp objects or toxic household items inaccessible to children. First aid supplies are available for children. The facility conducts fire drills/earthquake drills and was properly logged (08/25/2022). The disciplinary policy was discussed with Licensee today. The home has age-appropriate toys and equipment available for the children in care.

LPA reviewed 2 children's files and is in order.

continue to the next page.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jennifer Yee
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)
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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: DIAS, ANA PAULA
FACILITY NUMBER: 384004356
VISIT DATE: 12/02/2022
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LPA discussed Child Abuse Mandated Reporter Training AB1207 with Licensee. As of January 1, 2018, all staff will be required to complete Child Abuse Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. The licensee completed AB1207 on 11/12/21.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Sections 102417. When any IMS is provided, an updated Plan of Operation that includes 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

LPA discussed the safe sleep regulations with the licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. A sample infant sleep chart was provided. A blank form of LIC9227 was provided.

Notice of Site Visit posted and shall remain posted for 30 days.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jennifer Yee
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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