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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004467
Report Date: 08/18/2021
Date Signed: 08/18/2021 02:04:24 PM

Document Has Been Signed on 08/18/2021 02:04 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:NAMBA, MIHOFACILITY NUMBER:
384004467
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/18/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Miho NambaTIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Van met with Applicant Miho Namba and her husband for an announced pre-licensing inspection. This is a two-story single-family home. The Applicant rent the house, and property control was obtained during the inspection. The Department received an application for a Large Family Child Care home on July 27, 2021. However, on August 12, the Applicant decided to change the application from a Large to a Small Family Child Care Home. All documents obtained from the Applicant had been reviewed and met the Department's requirements. The resident of the home is the Applicant, her husband, and a minor child. The entire house is inspected for health and safety hazards. Days and operations are Monday – Friday from 8:30 AM – 4:30 PM.

LPA and the Applicant inspected the entire home for Health and Safety Hazards. The house consists of two bedrooms and one bathroom. Daycare areas are the living, dining room, bedroom #1, and bathroom. Off-limit areas are the kitchen, bedroom #2, and the laundry room on the second floor; the entire ground floor, including the garage, the backyard, and two storage spaces. All toxic or dangerous chemicals are stored in cabinets in the bathroom with child protective locks installed, making them inaccessible to children. The use of baby-gate barricades all off-limit areas. Per Applicant, there are no firearms, weapons, or pets on the premises. The isolation area for sick/ill children will be the hallway by the main entrance. The house has multiple smoke alarms & carbon monoxide detectors. The Applicant plans to use a mobile phone during daycare hours if an emergency occurs and use the wall by the entrance for required Licensing posting. There are sufficient age appropriated toys, furniture, and napping equipment in the daycare. The bathroom is clean, and no hazardous material is accessible to children. The Applicant stated that the facility would be providing morning and afternoon snacks for children. LPA advised the Applicant to conduct an emergency drill once every six months and document the exercises. The Applicant was informed that NO baby walkers, exer-saucers, jumpers, bouncers, and any similar items to be used for children in care and shall be made inaccessible. LPA also reminded the Applicant that smoking is prohibited at the daycare. The Applicant stated she plans to purchase liability insurance. continued on the next page...
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE: DATE: 08/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/18/2021
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: NAMBA, MIHO
FACILITY NUMBER: 384004467
VISIT DATE: 08/18/2021
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The Applicant has submitted the 16 hours of CPR/First Aid and health & safety training certification to the Department. Posting of Parent's Rights and the Emergency Disaster Plan was discussed with the Applicant. Records to be maintained were consulted and reviewed with the Applicant. The Applicant was informed to obtain a copy of regulations and current licensing forms through the Department's website at www.ccld.ca.gov. LPA also reminded the Applicant of the Family Child Care Home License's responsibilities and Reporting requirements. The Applicant was advised to post the License when she receives it.

The Applicant was informed that all adults 18 years and older living in the home, helper, or assistant must have fingerprint clearance associated with the facility. Failure to do so could result in an immediate civil penalty of $100.00 each day. Safe sleep was reviewed with the Applicant. LPA reminded Applicant that per Safe Sleep, to prevent SIDS, doors need to remain open for sleeping infants to allow for visual observation and check on infants every 15 minutes. The Applicant was informed about the Provider Information Notices (PINs) on the CCLD website and the sign-up process. The Applicant was also reminded of Mandated Reporter Online Training for Child Care Providers (AB 1207) and the additional General Training, and both are available on www.mandatedreporteca.com. The 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.

Also discussed were the IMS (Incidental Medical Service) policies. 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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at http://www.ada.gov/childqanda.htm

Prior to licensure, the following issue must be addressed.
- The Applicant will need to install a screen for all open-face heaters.
- All doors where children have access to need to have childproof door-handle installed.
- Purchase FirstAid Kit.

The report was reviewed and signed by the Licensee, Miho Namba. Today's report, 8/18/2021, and notice of site visit will be sent to the Licensee at mihonamba415@gmail.com by the close of business on 8/18/21. Confirmation of receipt is required.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2021
LIC809 (FAS) - (06/04)
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