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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004807
Report Date: 07/20/2021
Date Signed: 07/21/2021 11:24:46 AM

Document Has Been Signed on 07/21/2021 11:24 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:LEIB, HAUDY A.FACILITY NUMBER:
414004807
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
07/20/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Haudy LeibTIME COMPLETED:
12:00 PM
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On July 20, 2021 at 10:00am, Licensing Program Analyst (LPA), Catrina Quimbo, conducted an announced, relocation, pre-licensing inspection. LPA met with licensee, Haudy Leib. At the time of the inspection, licensee’s husband, adult daughter, adult son-in-law and two minor granddaughters were present in the home. Licensee is currently licensed (Fac#414004724). Licensee applied for a relocation on 06/09/2021. A health and safety inspection was conducted inside the home.

Licensee rents a two story, single family home. Licensee lives with husband, adult daughter, adult son-in-law and two minor granddaughters. All adults in the home have fingerprint clearance and are associated to facility. The home consists of 4 bedrooms, 3 bathrooms, living room, den, kitchen, dining area, backyard, side alleys, and garage. The DAY CARE AREAS are bedroom#1 (located on first floor), bathroom #1, living room, den, kitchen, dining area, backyard and side alleys. The OFF LIMITS AREAS are bathroom #2 (located on first floor), garage, bedroom #2, bedroom#3, bedroom#4 and bathroom#3. Licensee has installed child proof, locked gates preventing children’s access to stairs.

LPA observed the home to be clean, safe and with a working smoke and carbon monoxide detector, fully charged fire extinguisher (2A10BC). The home does not contain a fireplace. The licensee has a fully stocked First Aid kit.

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SUPERVISORS NAME: Suzanne Roman-Clark
LICENSING EVALUATOR NAME: Cindy Interiano
LICENSING EVALUATOR SIGNATURE: DATE: 07/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/20/2021
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: LEIB, HAUDY A.
FACILITY NUMBER: 414004807
VISIT DATE: 07/20/2021
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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 a variety of 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 or weapons in the home. Licensee has a small dog in the home. Per licensee, dog is a small Chiweenie mix and is up to date on immunizations. LPA advised licensee to keep pets separate from children in care.

Licensee was reminded baby walkers, bouncers, jumpers and any other similar items are not to be used for children in care. LPA did not observe bathroom #1 to have accessible poisonous or hazardous materials to children in care. Licensee to provide cribs and cots for napping children in care. Parents to provide sheets and blankets. 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.

LPA observed outdoor area to have age appropriate equipment and in good working condition. Entire backyard area is enclosed with a fence and cushioned with both artificial turf and grass. There are no bodies of water or additional living spaces on the home’s property. Backyard area beyond fence leads to lake.

CPR and First Aid training certificate expired 07/2021. Mandated Reporter training certificate will expire 07/2023. Required postings are posted in front of home. 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.

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

DATE: 07/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2021
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: LEIB, HAUDY A.
FACILITY NUMBER: 414004807
VISIT DATE: 07/20/2021
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Prior to recommended licensure, following must be completed:

-Renewal of EMSA certified CPR and First Aid certificate

-Additional netting to backyard fence, preventing access to lake

-Additional child safety locks to backyard fence, preventing acces to lake

-Child proof door handles and/or gates installed to OFF-LIMIT AREAS including

-Bathroom #2

-Door to garage door

-Child proof knob handles installed on stove.

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 at hanaileib@gmail.com. Licensee was advised to acknowledge receipt of report once received.
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2021
LIC809 (FAS) - (06/04)
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