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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410504500
Report Date: 06/14/2022
Date Signed: 06/14/2022 02:34:31 PM

Document Has Been Signed on 06/14/2022 02:34 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:CANESSA, ANGELAFACILITY NUMBER:
410504500
ADMINISTRATOR:CANESSA, ANGELAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 325-8373
CITY:MENLO PARKSTATE: CAZIP CODE:
94025
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
06/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Angela Canessa & Jeannie GallagherTIME COMPLETED:
02:45 PM
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On June 14, 2022 at approximately 12:00pm, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, annual inspection. LPA met with licensee, Angela Canessa, and explained the purpose of the inspection. Present in the home were licensee, licensee's helper (H1), and 10 enrolled children (2 infants and 9 preschool age). Licensee is operating within capacity ratio and limits on this date. All adults living and/or working in the home have a criminal record clearance on file. Hours of operation are Monday to Friday from 8:00am to 5:00pm. Licensee requested LPA to complete inspection with H1.

Licensee owns the home which is a multi-level, family home. The home consists of two levels. The DAY CARE AREAS are on the first level of the home that includes garage (converted into day care room), kitchen (pass by only), bathroom #1, nap room and backyard area. The OFF LIMIT AREAS are the entire second level of the home. All off limit areas are barricaded with child safety gates.

At approximately 12:15pm, LPA toured day care areas with H1. LPA observed home to be in good repair with proper temperature and ventilation. There were a variety of age appropriate toys and equipment in the home which were in good condition. LPA did not observe any poisons, cleaning supplies or other chemicals in any day care area. Home is equipped with a smoke detector, fully charged fire extinguisher and a working telephone on site. Phone number listed for licensee is current. Per H1 and licensee, there are no weapons or firearms in the home. Licensee utilizes cribs and mats for napping children in care. LPA observed napping room to be clean with appropriate sleeping equipment.

The backyard is enclosed with at least 5 ft high fence. Backyard is equipped with appropriate outdoor toys and equipment. LPA did not observe any pools, spas or bodies of water on the property.

LPA reviewed ten children’s records which were complete. Children’s files have a record of emergency identification information on file. Both licensee and H1 have a current CPR/Pediatric First Aid certificate. Licensee's CPR will expire 12/2023 and H1's CPR will expire 07/2022.

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SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE: DATE: 06/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/14/2022
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 3
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: CANESSA, ANGELA
FACILITY NUMBER: 410504500
VISIT DATE: 06/14/2022
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During Inspection:
-Licensee and H1 were given information regarding PIN 20-24-CCP Safe Sleep Regulation and lead poisoning facts flyer.
-Licensee and H1 were reminded as of September 1, 2016, all Staff and Volunteers must provide proof of immunization against pertussis, measles, and influenza, or qualifies for an exemption, pursuant to Health and Safety code 1596.7995 and 1597.622.
-Licensee and H1 were reminded about Mandated Reporter training available on www.mandatedreporterca.com. Training must be completed every 2 years by all staff hired.
-Licensee and H1 were reminded about Provider Information Notices (PINs) on CCLD website.
-Licensee and H1 were advised for any additional questions to contact CCLD office, Monday to Friday, 8:00am - 5:00pm, (650) 266-8800 or 1 (844) 538-8766. Website: www.cdss.ca.gov.

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: www.ada.gov/childqanda.htm.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process

Licensee and facility representative were reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record 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.

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SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2022
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: CANESSA, ANGELA
FACILITY NUMBER: 410504500
VISIT DATE: 06/14/2022
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LPA discussed the safe sleep regulations with licensee and H1, 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 and H1 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.

No deficiencies were cited today under CCR, Title 22, Div. 12, Chapt. 1.

A notice of site visit was given and must remain posted for 30 days.

An exit interview conducted and report was reviewed with facility representative, H1.
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2022
LIC809 (FAS) - (06/04)
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