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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410518784
Report Date: 09/10/2024
Date Signed: 09/10/2024 02:56:11 PM

Document Has Been Signed on 09/10/2024 02:56 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:CAPOVILLA, LUCYFACILITY NUMBER:
410518784
ADMINISTRATOR/
DIRECTOR:		CAPOVILLA, LUCYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 703-5454
CITY:SAN MATEOSTATE: CAZIP CODE:
94402
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
09/10/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Licensee, Lucy CapovillaTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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On September 10, 2024, at approximately 1:00pm, Licensing Program Analyst (LPA) Melissa Zaragoza, conducted an unannounced, annual inspection. LPA was greeted and granted access by licensee, Lucy Capovilla. At the entrance licensee was explained the purpose of the inspection. Present during LPA's visit included Licensee and 4 children (3 infants, and 1 preschool age child).

Hours of operation are Monday through Friday from 7:00am to 5:30pm. Licensee lives in a one-level home with their adult daughter, and adult niece. All adults living in the home have fingerprint clearance on file.

The DAY CARE AREAS are bedroom #1 (napping room), bedroom #2 (napping room), playroom, and bathroom #1. The OFF LIMIT AREAS are the garage, kitchen, dining room, living room, bedroom #3, bathroom #2, and backyard. Off limit areas in the home are inaccessible to children with a child safety gates.
LPA toured day care areas of home with the licensee. LPA observed home to be in good repair with proper temperature and ventilation. Home is equipped with a variety of toys and materials that were observed to be in good condition. LPA observed electrical outlets to be made inaccessible with child safety covers. Cleaning supplies, poisons and hazardous materials are stored in homes off limit area.

Home is equipped with a fully charged fire extinguisher and a dual smoke and carbon monoxide detector. Smoke and carbon monoxide detector was tested during the visit and was observed to be in working condition. There are no pools, and bodies of water in the premises.

Napping rooms (bedroom#1 and bedroom#2) were observed to be equipped with a playpen for napping children. Playpens were observed to be free of loose articles, bumper pads and pillows. Sleeping logs for napping infants are maintained and includes the 15-minute time check of when infant was last checked on and sleeping position.

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SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE: DATE: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/10/2024
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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: CAPOVILLA, LUCY
FACILITY NUMBER: 410518784
VISIT DATE: 09/10/2024
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Bathroom was observed to be in proper working condition. There is appropriate sanitation and toileting equipment for children in care. Per licensee, children’s families provide diapers and wipes for enrolled children. LPA observed children’s diaper to be stored in a closet, in the playroom. Diapers and wipes are labeled with each individual childs name.

Children eat in the playroom. A food service is provided to children that includes lunch and snack. LPA observed eating area to be clean and equipped with appropriate dining furniture. Per licensee, there are no children with dietary restrictions or allergies. LPA observed knives to be made inaccessible.

Per licensee, the backyard outdoor area is off limits. Per licensee, they take the children to the park daily, in the mornings. Park is across the street from of the home. LPA observed park, park is right in front of the home. LPA reminded licensee to observe children whenever they are in shared public places. LPA did not observe any pools, spas or bodies of water on site.

LPA reviewed 4 children's records which were complete. LPA reviewed licensee records, which were complete. Licensee has a current CPR/First Aid certifications and current Mandated Reporter certification. Licensee's CPR/First Aid certification will expire on 03/2025 and Mandated Reporter certification will expire 02/24/2026.

Emergency disaster drills are conducted and are appropriately documented. Last disaster drill was conducted September 06, 2024. LPA observed licensing documentation to be properly posted, made available for review. Facility maintains a childcare roster that was also made available for review. Per licensee, there are no weapons or firearms in the home.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

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SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2024
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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: CAPOVILLA, LUCY
FACILITY NUMBER: 410518784
VISIT DATE: 09/10/2024
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Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the licensee, Lucy Capovila, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed a Megan’s Law search on 7/31/24.

No deficiencies were issued during today's visit. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Lucy Capovilla.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2024
LIC809 (FAS) - (06/04)
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