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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004841
Report Date: 09/29/2021
Date Signed: 09/29/2021 12:13:20 PM

Document Has Been Signed on 09/29/2021 12:13 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:DIAZ, ELIZABETHFACILITY NUMBER:
414004841
ADMINISTRATOR:DIAZ, ELIZABETHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 445-5224
CITY:MENLO PARKSTATE: CAZIP CODE:
94025
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
09/29/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Elizabeth DiazTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Kaur met with Applicant Elizabeth Diaz for an announced pre-licensing inspection. This is a single-family home. The Applicant lives with her parents, and property control was obtained during the inspection. Applicants father owns property. The Department received an application for a Large Family Child Care home on September 19, 2021. All documents obtained from the Applicant had been reviewed and met the Department's requirements. The resident of the home is the Applicant, her mother and father. The entire house is inspected for health and safety hazards. Days and operations are Monday – Friday from 7:30 AM – 3:30 PM.

LPA and the Applicant inspected the entire home for Health and Safety Hazards. The house consists of 4 bedrooms and 2 bathroom. Daycare areas are the living, dining room and 1 bedroom, front yard and patio. Off-limit areas are the kitchen, bedroom #2,3,4 and backyard. All toxic or dangerous chemicals are stored in cabinets in the garage. The use of baby-gate barricades all off-limit areas. Per Applicant, there are no firearms, weapons, on the premises. Applicant has pet dog. The isolation area for sick/ill children will be by couch in living room. The house has multiple smoke alarms & carbon monoxide detectors. The Applicant plans to use a mobile phone during day care hours if an emergency occurs and use the wall by the entrance for required Licensing posting. There are sufficient age appropriated toys, furniture, and napping equipment in the daycare. The bathroom is clean, and no hazardous material is accessible to children. The Applicant stated that the facility would be providing morning and afternoon snacks for children. LPA advised the Applicant to conduct an emergency drill once every six months and document the exercises. The Applicant was informed that NO baby walkers, exer-saucers, jumpers, bouncers, and any similar items to be used for children in care and shall be made inaccessible. LPA also reminded the Applicant that smoking is prohibited at the daycare.
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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Harsimran Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 09/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/29/2021
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: DIAZ, ELIZABETH
FACILITY NUMBER: 414004841
VISIT DATE: 09/29/2021
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The Applicant has submitted the 16 hours of CPR/First Aid and health & safety training certification to the Department. Posting of Parent's Rights and the Emergency Disaster Plan was discussed with the Applicant. Records to be maintained were consulted and reviewed with the Applicant. The Applicant was informed to obtain a copy of regulations and current licensing forms through the Department's website at www.ccld.ca.gov. LPA also reminded the Applicant of the Family Child Care Home License's responsibilities and Reporting requirements. The Applicant was advised to post the License when she receives it.

The Applicant was informed that all adults 18 years and older living in the home, helper, or assistant must have fingerprint clearance associated with the facility. Failure to do so could result in an immediate civil penalty of $100.00 each day. Safe sleep was reviewed with the Applicant. LPA reminded Applicant that per Safe Sleep, to prevent SIDS, doors need to remain open for sleeping infants to allow for visual observation and check on infants every 15 minutes. The Applicant was informed about the Provider Information Notices (PINs) on the CCLD website and the sign-up process. The Applicant was also reminded of Mandated Reporter Online Training for Child Care Providers (AB 1207) and the additional General Training, and both are available on www.mandatedreporteca.com. The Applicant was informed that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.

Also discussed were the IMS (Incidental Medical Service) policies. 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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at http://www.ada.gov/childqanda.htm

Prior to licensure, the following issue must be addressed.
- Fire clearance needed.
- Fingerprint clearance for father.

The report was reviewed and signed by the Licensee, Elizabeth Diaz. Today's report, 09/29/2021, and notice of site visit will be sent to the Licensee at Elidayz86@yahoo.com by the close of business on 09/29/21. Confirmation of receipt is required.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Harsimran Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021
LIC809 (FAS) - (06/04)
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