<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004793
Report Date: 08/22/2022
Date Signed: 08/22/2022 02:09:43 PM

Document Has Been Signed on 08/22/2022 02:09 PM - 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: 6CENSUS: 6DATE:
08/22/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Talita CoimbraTIME COMPLETED:
02:55 PM
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 August 22, 2022 at approximately 1:30pm, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, case management inspection. LPA met with licensee, Talita Coimbra, and explained the purpose of the inspection. Present in the home were licensee, licensee's helper, and 6 enrolled children (1 infant and 5 preschool age). Licensee is operating within capacity limits and ratio during LPA's visit. All adults living and/or working in the home have a criminal record clearance on file.

Licensee is currently licensed for a small family child care home. Licensee requested to increase capacity 07/20/2022. Home received a fire clearance 08/01/2022. LPA inspected home for health and safety hazards.

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.

Home is clean with proper temperature and ventilation. Living room is separated into designated areas for play time, sitting/eating area and crawling area for infants. LPA observed home to have a variety of age appropriate toys and equipment that were in good condition. Living room contains a fire place that is properly barricaded and cushioned. Cleaning supplies, poisons and other chemicals were stored inaccessible to children in off limit areas. Per licensee, there are no weapons or firearms in the home.
(Continue Report on Page 2...)
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE: DATE: 08/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/22/2022
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 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: 08/22/2022
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
26
27
28
29
30
31
32
(Continued, Page 2...)
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 observed an inflatable pool in off limit area of backyard. LPA reminded licensee enrolled children are not to use inflatable pool in off limit area.

Capacity limits and ratios for a large family day care have been reviewed with licensee on this date. LPA reminded licensee that an assistant must be present when operating as a large license. LPA reminded licensee when an assistant is not present, licensee must operate as a small license. During visit, licensee provided LPA with updated lease agreement for current address.

Licensee's CPR and First Aid training is current and will expire 05/2024. Licensee was reminded baby walkers, bouncer, jumpers and any other similar items are not to be used for children in care. Licensee was reminded of safe sleep regulations in PIN 20-24-CCP.

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.

After today's visit, no deficiencies were cited today.

A large license has been recommended for facility effective 08/22/2022.

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

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

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

DATE: 08/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2