414004575-9-15-2021-05-CC-CQUO-C6VPHH-20210915111957

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004575
Report Date: 09/15/2021
Date Signed: 09/15/2021 11:20:37 AM

Document Has Been Signed on 09/15/2021 11:20 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:	ESPINOZA, YADIRA		FACILITY NUMBER:	414004575
ADMINISTRATOR:	ESPINOZA, YADIRA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 315-4277
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94403
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 5	DATE:	09/15/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Licensee, Yadira Espinoza		TIME COMPLETED:	11:30 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On September 15, 2021 at 9:00am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, annual required inspection. LPA met with Licensee, Yadira Espinoza, and explained purpose of inspection. Upon LPA’s arrival to home, one enrolled child arrived as well. During the inspection present in home were the Licensee, licensee’s two minor children (both preschool age) and one enrolled child (preschool age). 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 8:00am to 5:30pm. With Licensee, LPA conducted a health and safety inspection inside the home. Licensee is licensed for a large Family Child Care Home. The home is a double level house that consists of 5 bedrooms, 3 bathrooms, living room, dining room, kitchen, sun room, front yard, backyard area (upper level and lower level) and garage. The DAY CARE AREAS are (located on main level of home) the living room, dining room, sun room, bathroom #1, front yard and upper level of backyard area. The OFF LIMIT AREAS are all bedrooms, bathroom #2, bathroom #3, kitchen, garage, and lower level of backyard area. All off limit areas are properly barricaded with locked doors and/or child safety gates. At approximately 9:15am, LPA toured day care areas of home with Licensee. LPA observed home to be clean, in good repair with proper temperature and ventilation. There were a variety of age appropriate materials, toys and equipment in the home which were in good condition. All cleaning supplies, poisons and other chemicals were stored inaccessible to children. There was a working smoke detector and carbon monoxide detector, a fully charged fire extinguisher and working telephone. Phone number listed for licensee is current. (Continue Report on Page 2...)

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2021

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: ESPINOZA, YADIRA	FACILITY NUMBER: 414004575
	VISIT DATE: 09/15/2021

NARRATIVE

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Per Licensee, there are no weapons or firearms in the home. Home consists of 2 fireplaces which are properly barricaded and inaccessible to children in care. There were no pools, spas or bodies of water on the property. Outdoor toys in the backyard were age appropriate and in good repair.

LPA reviewed 2 children’s records which were complete. All children have a record of emergency identification on file. LPA reviewed Licensee’s file which was complete. Licensee’s Pediatric First Aid/CPR is current and will expire November 2022. Licensee’s Mandated Reporter Training is current and will expire August 2023. LPA reviewed safe sleep logs for napping infants in care. Safe sleep logs are properly documented and maintained. Facility’s last emergency drill was conducted July 5, 2021. Emergency drills are properly logged.

Incidental Medical Services (IMS) was discussed. Licensee has no children who need services 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 Americans with Disabilities Act (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.

During inspection:
- Licensee was given annual fee and PIN information.
- Licensee was reminded own children under the age of 10 years are included in facility capacity.
- Licensee was reminded accessible heater vents in floors in day care areas are to be properly covered.
- Licensee was given information regarding updated Safe Sleep Regulations, CA DPH Guidance for Use of Face Coverings, and Receiving Important Updates.
-Licensee was 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 was reminded about Mandated Reporter training available on CCLD website. Training must be completed every 2 years by all staff hired. Training can be taken online at www.mandatedreporterca.com.
-Licensee was reminded about the Provider Information Notices (PINs) on CCLD website.
-Licensee was 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.

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SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2021

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: ESPINOZA, YADIRA	FACILITY NUMBER: 414004575
	VISIT DATE: 09/15/2021

NARRATIVE

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No deficiencies cited today under CCR, Title 22, Division 12, Chapter 3.

After today's inspection, an exit interview was conducted with Licensee, Yadira Espinoza. This report was discussed and reviewed. This report is public and can be reviewed. A copy of report and Notice of Site Visit was emailed to licensee. Licensee was advised to acknowledge receipt of the report. Licensee was reminded that a site notice shall be posted in a prominent place in facility for 30 days during the hours of operation. Failure to maintain postings as required will result in a civil penalty of $100 a day.

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2021

LIC809 (FAS) - (06/04)

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