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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004793
Report Date: 06/09/2021
Date Signed: 06/11/2021 11:59:29 AM

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:COIMBRA, TALITA MIRELLEFACILITY NUMBER:
414004793
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
06/09/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:Talita CoimbraTIME COMPLETED:
02:00 PM
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Due to COVID-19 and DPH guidelines of social distancing, Licensing Program Analyst (LPA) Catrina Quimbo conducted the Pre-Licensing tele-inspection via FaceTime on June 9, 2021 at 12:55pm with licensee, Talita Coimbra. Present at the home during the tele-inspection was licensee and licensee’s two minor children. Licensee is currently licensed at 162 36th Avenue, San Mateo, Ca 94403 (Fac#414004744). Licensee applied for a relocation 05/03/2021. A health and safety inspection was conducted inside the home.

Licensee rents a two story, single-family home. Licensee lives in the home with her husband and two minor children. All adults living in home have current fingerprint clearance. The home consists of three bedrooms, two bathrooms, living room, dining room, kitchen, laundry room and backyard. The DAY CARE AREAS are the living room, bathroom #1 (located on upper level) and backyard. The OFF-LIMITS AREAS are bedroom #1 (located on ground level), bedroom #2, bedroom #3, bathroom #2, patio, kitchen, dining room, and laundry room. Licensee has installed child proof gates, preventing children’s access to the kitchen, dining room and stairs.

LPA observed the home to be clean, safe and with a working smoke and carbon monoxide detector, fully charged fire extinguisher (2A:10BC). The licensee has a fully stocked First Aid kit and thermometer. Licensee uses a designated cell phone and is aware the cell phone must stay within the home during the day care hours. The home contains a fireplace that is barricaded with a child proof, locked gate and covered with bubble wrap. The home has age appropriate toys and equipment available for the children in care. All electrical outlets children have access to have child safety covers and/or are blocked by furniture. All harmful and sharp objects are made inaccessible from children in care. Per licensee, there are no firearms, weapons or pets in the home. Licensee was reminded baby walkers, bouncers, jumpers and any other similar items are not to be used for children in care. LPA did not observe bathroom #1 to have accessible poisonous or hazardous materials to children in care. Licensee to provide cribs and cots for napping children in care. Per licensee, parents are to provide sheets and blankets. Safe sleep regulations, COVID-19 guidelines and sanitization were discussed.



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SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8864
LICENSING EVALUATOR NAME: Catrina QuimboTELEPHONE: (650) 393-8293
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2021
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 2
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: COIMBRA, TALITA MIRELLE
FACILITY NUMBER: 414004793
VISIT DATE: 06/09/2021
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LPA observed backyard area to have age appropriate equipment and in good working condition. Entire backyard area is enclosed with an least 5ft high fence. Half of backyard area is cushioned with artificial turf. Other half of backyard area contains concrete and wood chips. Part of backyard area is made inaccessible to children in care with a child proof locked gate. There are no bodies of water or additional living spaces. CPR and First Aid training certificate will expire 09/2021. Mandated Reporter training certificate will expire 01/2023. Required postings are posted near main entrance of living room. Licensee was advised all adults, 18 years and older living in the home, helper, assistant, or volunteer must have criminal record clearance and must be associated to the facility prior to having any contact with children in care. Failure to do so could result in an immediate civil penalty of $100 a day.

Prior to recommended licensure, licensee must complete the following:

-Proof of COVID-19 posters
-Child proof knobs and/or child safety gates to off-limit areas in home including:
-Laundry room
-Bedroom #2
-Bedroom #3
-Age-appropriate materials for bathroom #1
-Extension of child safety gate in backyard

Licensee was advised to contact San Bruno Regional Office for concerns or questions. Desk Duty is available M-F, 8:00am to 5:00pm at (650) 266-8800. Forms and regulations are made available at www.cdss.ca.gov/inforesources/Community-Care-Licensing

This report is public and can be reviewed. A copy of this report will be emailed to licensee. Licensee was advised to acknowledge receipt of report once received.
SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8864
LICENSING EVALUATOR NAME: Catrina QuimboTELEPHONE: (650) 393-8293
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2021
LIC809 (FAS) - (06/04)
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