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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414000479
Report Date: 12/28/2021
Date Signed: 12/28/2021 02:52:50 PM

Document Has Been Signed on 12/28/2021 02:52 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:PORTILLO, EDITH M.FACILITY NUMBER:
414000479
ADMINISTRATOR:PORTILLO, EDITH M.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 323-5903
CITY:EAST PALO ALTOSTATE: CAZIP CODE:
94303
CAPACITY: 14TOTAL ENROLLED CHILDREN: 9CENSUS: 4DATE:
12/28/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Edith PortilloTIME COMPLETED:
12:40 PM
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On December 28th, 2021 at 10:30am, Licensing Program Analyst (LPA) Tapia-Mandujano conducted an unannounced Annual Required inspection. LPA met with Licensee, Edith Portillo and explained purpose of inspection. Present in the home were Licensee, licensees' husband/assistant caring for 4 enrolled children (2 infants, 2 preschool age). All adults living and working in the home have a criminal record clearance on file.

Licensee owns home, which is a 3 bedroom, 2 bathroom, single story house with an in-law unit in the backyard. Hours of Operation are Monday-Friday from 6am-6pm. Daycare areas are: Kitchen/dining area, Living Room, Bathroom #1, and section of Backyard. Off Limit areas are: Bedrooms #1, #2, and #3, Bathroom #2, Garage, Front yard, section of backyard, and in-law unit in the backyard. Off limit areas, including closets, are properly barricaded.

LPA toured day care areas of home with Licensee. 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. There were no pools, spas or bodies of water on the property. All cleaning supplies, poisons and other chemicals were stored inaccessible to children behind child safety locked cabinets.

There was a fully charged fire extinguisher and a working telephone on site. Phone number listed for Licensee is current. Per Licensee, there are no weapons or firearms in the home. LPA reviewed children’s records. LPA also reviewed licensee's records. Licensees CPR & First Aid Certificate expires on 12/2021. Last emergency drill was conducted 12/01/2021. Emergency drills are conducted at least once every six months and moving forward licensee agrees to properly log the Emergency Drills.

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SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE: DATE: 12/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/28/2021
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: PORTILLO, EDITH M.
FACILITY NUMBER: 414000479
VISIT DATE: 12/28/2021
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Incidental Medical Services (IMS) policy was discussed. Licensee does offer IMS at this time. 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/inspection-process.

Licensee was 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.

LPA discussed the safe sleep regulations with 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.

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

A notice of site visit will be emailed and must remain posted for 30 days.

An exit interview conducted and report was reviewed with the licensee, Edith Portillo.
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE:

DATE: 12/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2021
LIC809 (FAS) - (06/04)
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