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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414001409
Report Date: 08/29/2022
Date Signed: 08/29/2022 10:43:57 AM

Document Has Been Signed on 08/29/2022 10:43 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:DIAZ, MARIA BETTINA C.FACILITY NUMBER:
414001409
ADMINISTRATOR:DIAZ, MARIA BETTINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 579-2678
CITY:SAN MATEOSTATE: CAZIP CODE:
94401
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 2DATE:
08/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Maria DiazTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Marie Rodriguez made an unannounced annual inspection. LPA met with Licensee Maria Diaz and explained purpose of inspection. Present in the home were the licensee and two children (one infant and one preschool aged). Licensee is operating within capacity requirements on this day. All adults living or working in the home have a criminal record clearance on file. Hours of operation are Monday to Friday from 7:30 am to 6:00 pm.

Daycare Areas: Living room, dining room, kitchen, bathroom in garage area, and backyard. Off Limit Areas: Garage, bedroom #1, bedroom #2, bedroom #3, and bathroom #2. All off limit areas, including all closets are properly barricaded. LPA toured day care areas of home with Licensee. Home is clean and orderly with sufficient lighting and ventilation. Home has age appropriate toys and equipment available for children in care. Fireplace is fully covered by a bookcase. Home has a working smoke and carbon monoxide detector, a working telephone, and a fully charged fire extinguisher. First Aid Kit is fully stocked and accessible. There are no pools, spas, or bodies of water on the property. All cleaning supplies, poisons, and other chemicals are stored inaccessible to children. All harmful and sharp objects are made inaccessible from children in care. Licensee states there are no guns or weapons in the home.

Two children's records reviewed were complete. All children have a record of emergency identification information on file. Licensee's record reviewed were complete. Licensee's Pediatric First Aid/CPR certificate expires April 2024. Last emergency drill was conducted in July 2022. Emergency drills are conducted at least once every six months and are properly logged.

No deficiencies cited today under California Code of Regulations, Title 22, Division 12.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Marie Rodriguez
LICENSING EVALUATOR SIGNATURE: DATE: 08/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/29/2022
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: DIAZ, MARIA BETTINA C.
FACILITY NUMBER: 414001409
VISIT DATE: 08/29/2022
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Licensee was reminded about Mandated Reporter training available on CCLD website. Training must be completed every 2 years for Licensee and staff. Training can be taken online at www.mandatedreporterca.com. If training is not available in native language, a statement can be written stating exemption until the translation is available.

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 (US DOJ) 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.

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 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.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with Licensee Maria Diaz.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Marie Rodriguez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2022
LIC809 (FAS) - (06/04)
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