414004793-11-29-2023-05-CC-JTSE-CY32WG-20231129164532

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004793
Report Date: 11/29/2023
Date Signed: 11/29/2023 04:45:52 PM

Document Has Been Signed on 11/29/2023 04:45 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	COIMBRA, TALITA MIRELLE		FACILITY NUMBER:	414004793
ADMINISTRATOR:	COIMBRA, TALITA MIRELLE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 660-3032
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94403
CAPACITY:	12	CENSUS: 11	DATE:	11/29/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	02:20 PM
MET WITH:	Licensee, Talita Coimbra		TIME COMPLETED:	05:00 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 11/29/2023, at approximately 2:20PM, Licensing Program Analyst (LPA) Jonathan Tse conducted an unannounced required annual inspection. LPA was granted entry to the facility by Licensee, Talita Coimbra. LPA explained the purpose of the visit. Present in the facility were Licensee, two helpers, three infants and eight preschool age children. The facility is in compliance with capacity requirements. The facility’s normal operating hours are from 8:00AM to 5:00PM. The home is a multi-level three-bedroom, two-bathroom home. DAY CARE AREAS: Living Room, half of the Backyard. OFF-LIMIT AREAS: Bedroom #1 (located on ground level), Bedroom #2, Bedroom #3, Bathroom #2, Kitchen, Dining Area (pass by only), Laundry Room, and half of the Backyard. LPA inspected the home for any health and safety hazards. The home is kept in clean and orderly condition. There are age-appropriate toys and learning equipment in the Living Room for children. LPA observed cribs to be available for infant use. Children bring sheets to use from home, and the facility washes the sheets once a week. LPA observed a carbon monoxide detector and smoke detector to be operational. The home is equipped with a fully charged 4A60BC fire extinguisher. Cleaning supplies, poisons and other chemicals are stored inaccessible to children. All outlets are covered or obstructed by furniture to not be accessible to children. There is a fireplace in the Living Room that is barricaded by a childproof gate. All off-limits areas are barricaded and kept inaccessible to children. Per Licensee, there are no firearms kept in the home. Continued on Page Two

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Jonathan Tse	TELEPHONE: (650) 464-4927
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023

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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Document Has Been Signed on 11/29/2023 04:45 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: COIMBRA, TALITA MIRELLE	FACILITY NUMBER: 414004793
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/29/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.871(c)(1)(A)

Administration of Child Day Care Licensing

Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision (f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above in two out of four adults present in the home during the visit which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/06/2023
	Plan of Correction
1 2 3 4	Licensee shall have her adult son and H2 fingerprinted and associated to the facility by set due date of 12/6/2023. Licensee provided proof that H2 was previously fingerprinted for her facility, but H2 is not showing up on the roster.

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in three out of three staff members' Mandated Reporter Trainings which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/06/2023
	Plan of Correction
1 2 3 4	Licensee, in addition helpers H1 and H2, shall complete Mandated Reporter Training for Childcare Providers and submit proof of completion to LPA by set due date of 12/6/2023. mandatedreporterca.com

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Jonathan Tse	TELEPHONE: (650) 464-4927
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023

LIC809 (FAS) - (06/04)

Page: 2 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: COIMBRA, TALITA MIRELLE	FACILITY NUMBER: 414004793
	VISIT DATE: 11/29/2023

NARRATIVE

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The yard is currently not in use due to construction being done on the building’s upper levels. The yard is kept in clean and orderly condition. LPA did not observe any debris or other loose material to be present. There is sufficient cushioning for children in the form of artificial turf. The play equipment in the yard was observed to be clean and in good repair. There is a fence enclosing the yard that is at least five feet high. There are no pools or other bodies of water located in the facility. There is a dog in the home that is kept away from children in care in off-limits areas.

LPA reviewed three staff files and ten children’s files. All children’s files included emergency identification information, and Notification of Parent’s Rights (LIC995A). Licensee’s First Aid/CPR Training expires 5/2024. Licensee’s Mandated Reporter Training expired 1/2023. LPA discussed requirement to maintain Mandated Reporter Training. LPA discussed requirement to maintain proper documentation in all employee’s files.

LPA observed the following documents to be posted: Facility License and PUB394, Notification of Parents’ Rights. The facility last conducted an emergency drill on 10/30/2023. Emergency drills are properly logged and documented. The facility prepares breakfast, lunch, and AM/PM snacks for children.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Continued on Page Three

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Jonathan Tse	TELEPHONE: (650) 464-4927
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023

LIC809 (FAS) - (06/04)

Page: 5 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: COIMBRA, TALITA MIRELLE	FACILITY NUMBER: 414004793
	VISIT DATE: 11/29/2023

NARRATIVE

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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-andresources/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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

See LIC809-D for deficiencies cited today.

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

Exit interview conducted and report was reviewed with the licensee, Talita Coimbra.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Jonathan Tse	TELEPHONE: (650) 464-4927
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023

LIC809 (FAS) - (06/04)

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