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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002885
Report Date: 08/25/2022
Date Signed: 08/25/2022 11:47:18 AM

Document Has Been Signed on 08/25/2022 11:47 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:SANTIAGO, ANA BERTHAFACILITY NUMBER:
414002885
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
08/25/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Ana Bertha SantiagoTIME COMPLETED:
11:55 AM
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On 8/25/2022 at 8:50AM., Licensing Program Analyst (LPA), Luis J. Gomez met with Licensee, Ana Bertha Santiago. Purpose of the inspection was explained and was for an unannounced; annual random inspection. Present in facility was the licensee, licensee husband and four children (3 Preschool Age, 1 Infant Age). Adults present have their criminal record clearances on file. Fire Marshal arrived during today’s inspection. Licensee’s home is one level, with three bedroom and two bathroom. Days and hours of operation are Monday- Friday 8:00- 5:00pm. Day-Care areas are: Bedroom #1; Bedroom #2; Bathroom #1; Bathroom #2; Kitchen Area; Living Room, Playroom; and Outdoor Play Area. Off-Limit areas are: Bathroom #3. LPA inspected home with licensee for health and safety hazards.

At 9:00AM., the following was observed: Day-care was clean, orderly, and with age appropriate playthings available for the children. Furniture, toys and materials inspected were in good repair. Hangers are located in entry way for added storage. Kitchen Area had child sized tables and chairs for snack and activities. Safety locks had been installed on all accessible cabinets. For napping services, mats, playpens and cribs are stored in the bedroom #1, #2. Facility had at least one crib (with tight-fitting sheet) for each infant in care. Bathrooms were observed clean with adequate supplies for hand-washing. Bathroom fixtures tested were in operating condition. Accessible outlets and trash bins are covered. Detergents; cleaning compounds; wipes; spray bottles; and other items which could pose a danger, were stored under the kitchen sink. Facility was the proper temperature; ventilation and lighting. Home had functioning telephone; smoke detector; carbon monoxide detector; and a fully charged fire extinguisher, 3A:40BC. Home does not have any swimming pools, spas, hot tubs, fishponds or other bodies of water. (REFER TO 809C FOR CONT)
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/16/2022
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 4
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: SANTIAGO, ANA BERTHA
FACILITY NUMBER: 414002885
VISIT DATE: 08/25/2022
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(Page 2)
At 9:20AM., LPA inspected the outdoor play area. The outdoor spaces was completely enclosed. Outside playthings were in good repair. Storage shed was reviewed during inspection. Home does not have pools, fishponds, bodies of water on the premises.

At 9:35AM, LPA reviewed the facility and children’s records. Children's records were reviewed and included their Identification of Emergency Information (LIC700); Consent for Medical Treatment (LIC627); Immunization Records; and Notification of Parent’s Rights (LIC995A).

At 9:50AM., Based on record review and interview, LPA confirmed licensee is not maintaining proper documentation of infant napping conditions for qualifying infant in care. During inspection, Advisory Note: Technical Assistance (LIC9102TA) was issued.

Licensee’s required mandated reporter training certification (AB1207) was current expiring: 1/29/2024. Licensee’s Cardiopulmonary Resuscitation (CPR)/ First Aid Certification was current, expiring: 6/11/2023

Licensee is conducting emergency disaster drills; with last drill completed on 4/15/2022, properly logged.

LPA observed required posting, including: Facility License; Notification of Parent’s Rights; and Emergency Disaster Plan (LIC610A). Updated Children's Roster (LIC500) was reviewed during inspection. Per licensee, isolation of ill children is in the playroom.

Per licensee, facility provides all lunch and snack for children in care. LPA reminded licensee to ensure all children’s food containers brought to facility by families are properly labelled. Per licensee, her home does not have any firearms or weapons.

Licensee was reminded that all adults 18 years and over, living or working in the home, including employee and volunteers, must obtain criminal 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.


(REFER TO 809C, FOR CONT.)
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: SANTIAGO, ANA BERTHA
FACILITY NUMBER: 414002885
VISIT DATE: 08/25/2022
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(Page 3)
LPA discussed the safe sleep regulations with licensee and discussed Child Care Licensing Safe Sleep Web page at:https://www.cdss.ca.gov/inforesource/child-care-licesning/public-information-and-resources/safe-sleep as an additional resource. LPA informed licensee of the importance of checking for recalled infant devices on United States consumer Product Safety Commission (CPSC) website at http://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

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 tool, please send them 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/inforesource/community-care-licensing/inspection-process.

Based on today's inspection, no deficiencies were observed in areas evaluated according to California Title 22, Health and Safety Code of Regulations. Exit interview was discussed with Licensee, Ana Bertha Santiago and signature of this form acknowledges receipt of these documents.



Notice of Site Visit was provided and must be posted for 30 days.

This report must be available in the facility for public review. Licensee was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2022
LIC809 (FAS) - (06/04)
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