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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004688
Report Date: 07/28/2021
Date Signed: 07/28/2021 10:00:26 AM

Document Has Been Signed on 07/28/2021 10:00 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:BRAVO, JULIA A.FACILITY NUMBER:
414004688
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
07/28/2021
TYPE OF VISIT:Required - 1 YearANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Licensee, Julia BravoTIME COMPLETED:
10:05 AM
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On July 28th, 2021, at 9:25am, Licensing Program Analyst (LPA) Kassandra Medrano conducted an annual required inspection which included a tour of the home and yard, and a review of the required day-care forms with the licensee today. Present in the home is Licensee, Julia Bravo. This type of home is a Duplex, licensee lives on bottom floor. Off limit rooms were identified as Bedroom #1, Kitchen, Side yard, and half of the garage. A review of records indicates that all adults working or living in the home who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Licensee rents home. The day-care operates 8am-5:30pm, Monday through Friday. Licensee does not have insurance and will have parent’s sign the affidavit. LPA observed the following: Day-care area is clean, orderly, and equipped with age appropriate toys and equipment for the children. No baby walkers, bouncers, exercausers, etc. allowed to be used during day-care hours. Home has proper lighting and ventilation. Home has a working telephone, a working smoke and carbon monoxide detector, and a fully charged 2A10BC fire extinguisher. Licensee states there are no bodies of water on the property. There is not a fireplace in the day-care area. There are no detergents, or cleaning products accessible to day-care children. Poisons are locked. Licensee states there are no guns or weapons of any kind in the home. The yard is fenced. Licensee states there are not pets in the home. Licensee’s CPR and First Aid expires 12/2021. Licensee will provide daily snacks and meals. Isolation of sick children reviewed/discussed. Supervision and transportation of children was discussed. Capacity options were reviewed. Licensee understands that care cannot be provided for more than the capacity as stated on the license. Requirements for reporting suspected child abuse was discussed, as well as reporting requirements for unusual incidences. All required postings are properly posted (License/Parent’s Rights poster/Emergency Disaster Plan and Earthquake Preparedness Checklist) Licensee has updated immunization's and Mandated Reporter Training on file.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Kassandra Medrano
LICENSING EVALUATOR SIGNATURE: DATE: 07/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/28/2021
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: BRAVO, JULIA A.
FACILITY NUMBER: 414004688
VISIT DATE: 07/28/2021
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Licensee was reminded that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.

Licensee was informed about the Provider Information Notices (PINs) on CCLD website. Licensee was reminded about Mandated Reporter Training available on CCLD website
(www.ccld.ca.gov or www.mandatedreporterca.com). Information regarding 'A Child Care Provider's Guide to Safe Sleep' was provided to the Licensee and is available for review on CCLD website.

No deficiencies were issued today under Title 22 Division 12 of the California Code of Regulations.
This report and appeal rights were discussed with Licensee. This report must be available in the facility for public review. Notice of Site Visit was posted. Notice to remain posted for 30 days.

Report was reviewed and signed by Licensee, Julia Bravo. Today’s report, 7/28/2021and notice of site visit will be to licensee at email address by close of business, date. Confirmation of receipt is required.*
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Kassandra Medrano
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2021
LIC809 (FAS) - (06/04)
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