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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004800
Report Date: 07/30/2021
Date Signed: 07/30/2021 12:02:14 PM

Document Has Been Signed on 07/30/2021 12:02 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:JAMESON, GLORIAFACILITY NUMBER:
414004800
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 3DATE:
07/30/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Licensee, Gloria JamesonTIME COMPLETED:
11:15 AM
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On July 30, 2021 at 9:00am, Licensing Program Analyst (LPA), Catrina Quimbo, conducted the relocation, pre-licensing inspection. LPA met with licensee, Gloria Cristina Jameson. Licensee is currently licensed (Fac#414004578). Licensee applied for a relocation on 05/18/2021. A health and safety inspection was conducted inside the home.

Licensee rents a one story, single family home. The home consists of 3 bedrooms, 2 bathrooms, living room, dining room, kitchen, garage and backyard area. The DAY CARE AREAS are living room, dining room, bedroom #1 (napping room), bathroom #1, and half of the backyard area. The OFF LIMITS AREAS are kitchen, bedroom #2, bedroom #3, bathroom #2, garage, and other half of backyard area.

LPA observed the home to be clean, safe and with a working smoke and carbon monoxide detector, fully charged fire extinguisher (2A10BC). The home contains a fireplace. Licensee uses a designated cell phone and is aware the cell phone must stay within the home during the day care hours. 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. Licensee to provide cribs, cots, and mats, parents to provide sheets for napping children in care. Safe sleep regulations, laundering, COVID-19 guidelines and sanitization were discussed. LPA reminded licensee emergency drills are to be conducted and documented once every six months.

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SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE: DATE: 07/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/30/2021
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: JAMESON, GLORIA
FACILITY NUMBER: 414004800
VISIT DATE: 07/30/2021
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LPA observed outdoor 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 (day care area) is cushioned with grass, turf and carpets. Other half of backyard area is made inaccessible to children in care with a child-safety gate/divider. There are no bodies of water or additional living spaces. CPR and First Aid training certificate will expire 06/2023. Mandated Reporter training certificate will expire 07/2023. 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, following must be completed:

-Fully barricade fireplace with child safety gate.

-Restock First Aid Kit.

-Install child safety locks to:

-closet and cabinet in living room

-cabinet in dining room

-cabinet in bathroom #1

-cabinets in hallways (located outside bedroom#1)

-closet in bedroom #1 (napping room)

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

DATE: 07/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2021
LIC809 (FAS) - (06/04)
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