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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004797
Report Date: 04/28/2022
Date Signed: 04/28/2022 04:53:41 PM

Document Has Been Signed on 04/28/2022 04:53 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:TORRES OLIVEROS, ANDREAFACILITY NUMBER:
414004797
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
04/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Andrea Torres OliverosTIME COMPLETED:
05:10 PM
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On 4/28/2022 at 2:00P.M., Licensing Program Analyst (LPA), Luis J. Gomez met with Licensee, Andrea Torres Oliveros. Purpose of the inspection was explained and was for an unannounced, Annual/ Random inspection. Present was the licensee and 3 adult occupants. Licensee is caring for six children. (3 Infant age, 3 preschool age) All adults have their criminal record clearances on file. Licensee’s home is a two bedroom, two bathroom, one story house. Day and hours of operation are Monday- Friday: 7:30am- 5:30pm. Day-care Areas are: Living Room (Playroom), Dining Area/ Kitchen, Bedroom #1 (Napping only), Bathroom #1 and Backyard Area Off-limit Area are: Bedroom #2, Bathroom #2 and Garage (Pass through only). LPA inspected home, inside and outside, with licensee for health and safety hazards.

At 2:10P.M., the following was observed: Home was clean with age- appropriate playthings available toys available for the children. All furniture and items inspected were in good repair. Dining Area had child size table with chairs for activities. Facility has individual drawers located in entry way for children belongings. For napping services, cleanable napping mattresses and playpens were in facility playroom and bedroom #1.

LPA reminded licensee to ensure all infant mattresses are the correct size and specifically made for the infant playpen. Facility had at least one playpen for each infant in care. Bathroom #1, located in hallway, was observed clean and with adequate supplies for the children. Bathroom fixtures were in proper operating condition. Off-limit areas had been made inaccessible with locked doors and child safety gates. Cleaning detergents, compounds, wipes, spray bottles and items which could pose a danger, were stored inaccessible to the day-care children. Facility was the proper temperature with adequate ventilation and sufficient lighting. Home had functioning telephone, smoke detector, carbon monoxide detector and fully charged fire extinguisher (3A:40BC). (REFER TO 809C FOR CONT.)

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 04/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/28/2022
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 4
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: TORRES OLIVEROS, ANDREA
FACILITY NUMBER: 414004797
VISIT DATE: 04/28/2022
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(Page 2)

At 2:20P.M, LPA inspected the outdoor play area. Area was completely enclosed and was free of hazards or dangerous conditions. Plaything inspected where in good condition. Canopy had been installed for added shading and was anchored. Licensee has placed turfing thought yard to absorbed potential falls. Home did not have any swimming pools, spas, hot tubs, fishponds or other bodies of water. Shed was reviewed during inspection.

At 2:45P.M., LPA reviewed facility and children’s records. Children's records were reviewed and included, (LIC700) Identification of Emergency Information, (LIC627) Consent for Medical Treatment, (LIC995A) Notification of Parent's Rights, Individual sleeping plan (LIC9227) for each qualifying infant in care.

Licensee is maintained required napping logs with documentation of each 15- minute check.

At 3:00P.M., Based on record review, LPA confirmed licensee missing required immunization record for child, C6, in care. During inspection Advisory Note: Technical Violation (LIC9102) was issued.

Licensee’s Cardiopulmonary Resuscitation (CPR)/ First Aid Certification was current, expiring 5/2022. Facility is conducting emergency disaster drills, with last drill completed on, 12/8/2021, properly logged.

Licensee’s mandated reporter training certification as current, expiring on 8/2022.

LPA observed required posting, including the: Facility License, Notification of Parent’s Rights and Emergency Disaster Plan (LIC610A) properly posted in facility. Children's roster (LIC500) was updated during inspection.

Per licensee, no children in care require incidental medical services at this time. Per licensee, facility provides lunch and snack for children in care. LPA asked staff to ensure all children’s food containers brought to facility by families are properly labelled. Per licensee, home does not have any no guns or weapons. Per licensee, there are no pets in the home. (REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: TORRES OLIVEROS, ANDREA
FACILITY NUMBER: 414004797
VISIT DATE: 04/28/2022
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Licensee was reminded that all adults 18 years and over living or working in the home, including employee and volunteers, must obtain criminal 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 Child Care Licensing Safe Sleep Web page at:https://www.cdss.ca.gov/inforesource/child-care-licesning/public-information-and-resources/safe-sleep as an additional resource. LPA informed licensee of the importance of checking for recalled infant devices on United States consumer Product Safety Commission (CPSC) website at http://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

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 tool, please send them 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/inforesource/community-care-licensing/inspection-process.

Based on today's inspection, no deficiencies were observed in areas evaluated, according to California Title 22, Health and Safety Code of Regulations. Exit interview was reviewed with licensee, Andrea Torres Oliveros and signature of this form acknowledges receipt of these documents.



Notice of Site Visit was provided and must be posted for 30 days.

This report must be available in the facility for public review. Licensee was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2022
LIC809 (FAS) - (06/04)
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