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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004793
Report Date: 05/18/2022
Date Signed: 05/18/2022 11:21:15 AM

Document Has Been Signed on 05/18/2022 11:21 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:COIMBRA, TALITA MIRELLEFACILITY NUMBER:
414004793
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 9CENSUS: 5DATE:
05/18/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Talita CoimbraTIME COMPLETED:
11:45 AM
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On May 18, 2022 at approximately 9:00am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, annual inspection. LPA met with licensee, Talita Coimbra, and explained the purpose of the inspection. Present in the home were licensee and 5 enrolled children (2 infants and 3 preschool age). Licensee is operating within capacity limits and ratio on this date. All adults living and/or working in the home have criminal record clearance on file.

Hours of operation are Monday to Friday from 8:00am to 5:00pm. Licensee rents the home which is a multi-level, single family home that includes three bedrooms, two bathrooms, living room, dining area, kitchen, laundry room and backyard. The DAY CARE AREAS are the living room, bathroom #1 (located on upper level) and half of backyard. The OFF-LIMITS AREAS are bedroom #1 (located on ground level), bedroom #2, bedroom #3, bathroom #2, kitchen, dining area (pass by only), laundry room and half of backyard. All off limit areas are properly barricaded with child proof gates and/or child safety locked doors.

At approximately 9:20am, LPA toured day care areas of home with licensee. LPA observed home to be in good repair with proper temperature and ventilation. Licensee has separated living room into separate designated areas for the children that include a play area, sitting/eating area, as well as a crawling area for infants. There were a variety of age appropriate toys and equipment in the home which were in good condition. All cleaning supplies, poisons and other chemicals were stored inaccessible to children in off limit areas. Home contains a fire place that is properly barricaded and cushioned. The backyard is enclosed with an least 5ft high fence. Portion of the backyard is utilized as a day care area while the other portion of the backyard is an off limit area. Portion of the backyard that is part of a day care area is equipped with age appropriate outdoor toys that were in good working condition. Backyard flooring is cushioned with artificial turf that was in good condition. LPA did not observe any pools, spas or bodies of of water on the property.

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SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE: DATE: 05/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/18/2022
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: COIMBRA, TALITA MIRELLE
FACILITY NUMBER: 414004793
VISIT DATE: 05/18/2022
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There was a smoke detector and carbon monoxide detector and a working telephone on site. Phone number listed for licensee is current. Per Licensee, there are no weapons or firearms in the home. LPA reviewed five children’s files that maintain a record of emergency identification information. Licensee's Pediatric First Aid/CPR has recently been renewed and will expire 05/2024. Licensee's Mandated Reporter training is current and will expire 01/2023. Licensee also has proof of required immunizations that were made available for review during inspection. Last emergency drill was conducted 01/10/2022. Licensee had proof of emergency disaster drills on cell phone. LPA reminded licensee emergency drills are to be documented and logged once every six months.

During Inspection:
- Licensee was given information regarding PIN 20-24-CCP Safe Sleep Regulation and Lead Poisoning Facts Flyer.
-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.

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 (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.

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SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2022
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: COIMBRA, TALITA MIRELLE
FACILITY NUMBER: 414004793
VISIT DATE: 05/18/2022
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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.

No deficiencies were cited today under CCR, Title 22, Div. 12, Chapt. 1.

A notice of site visit was given and must remain posted for 30 days.

An exit interview conducted and report was reviewed with the licensee, Talita Coimbra.
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2022
LIC809 (FAS) - (06/04)
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