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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004807
Report Date: 08/03/2022
Date Signed: 08/03/2022 01:33:09 PM

Document Has Been Signed on 08/03/2022 01:33 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:LEIB, HAUDY A.FACILITY NUMBER:
414004807
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
08/03/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Haudy LeibTIME COMPLETED:
11:40 AM
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On August 03, 2022 at approximately 9:35am, Licensing Program Analyst (LPA) Winnie Ly conducted a Case Management Visit initiated by the licensee to increase capacity for her family child care. LPA arrived to this family child care home and met with Licensee Haudy Leib. Purpose of visit was explained. Present during the visit were Licensee and daughter caring for 4 preschoolers and 2 infants.

LPA and licensee toured the home for heath and safety check. 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 home has a fully stocked First Aid kit. There is a lake in the back yard and has adequate netting to prevent children from falling through gaps.

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.

The home has been granted a Fire Clearance from the San Mateo Fire Department on 07/20/2022.

Large Family Child Care License is approved as of 08/03/2022.

A copy of this report will be emailed to Licensee whose signature on this form confirm have read these reports. This report will be kept in the facility file and will be made available for public review upon request. Desk duty is available M-F, 8a.m.-5p.m., (650) 266-8800. Website for forms and Regulations: www.cdss.ca.gov
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Winnie Ly
LICENSING EVALUATOR SIGNATURE: DATE: 08/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/03/2022
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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