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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004841
Report Date: 02/18/2022
Date Signed: 02/18/2022 01:26:59 PM

Document Has Been Signed on 02/18/2022 01:26 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: 14CENSUS: 1DATE:
02/18/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Elizabeth DiazTIME COMPLETED:
12:00 PM
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On February 18th, 2022 at 10am, Licensing Program Analyst (LPA) Tapia-Mandujano met with Applicant, Elizabeth Diaz for a second Pre-Licensing visit. Applicant has had a previous Pre-Licesing inspection on September 29th, 2021. Purpose of the visit was to inspect the Health and Safety Hazards in the home. Present in the home was applicant, applicants parents, and an infant child. Applicant has applied for a Large Family Child Care License. All adults living in the home have received fingerprint clearance and/or are associated.

Applicants rents home that consists of 4 bedrooms and 2 bathroom. Daycare areas: Living Room, Dining Room, Bedroom #2, Bathroom #1, and front and side yard. Off-limit areas: Kitchen, Bedroom #1,3,4/office, Bathroom #2, and backyard. All off limit areas are properly barricaded. LPA inspected applicant’s home for health and safety hazards.

LPA observed the following: Day-care is clean, orderly with a variety of age appropriate toys for the children. All furniture inspected is in good repair. LPA observed a working combination Smoke Detector/Carbon Monoxide alarm and a fully charged fire extinguisher (3A10BC). The applicant has a fully stocked First Aid kit and thermometer. Applicant has a dog. The home has no bodies of water or fireplace in the home. The garbage cans have tight fitting lids. The home has age appropriate equipment available for children in care. Applicant was reminded baby walkers, bouncers, jumpers and any other similar items are to not be used for children in care.

The home is clean and orderly with sufficient lighting and ventilation. Applicant states they will conduct an emergency drill once every six months and log drills. Applicant's CPR expire on 7/2023. Applicant was advised all adults, 18 years and older living in the home, helper, or assistant must have finger print 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 $100.00 each day.

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SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE: DATE: 02/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/18/2022
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 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: DIAZ, ELIZABETH
FACILITY NUMBER: 414004841
VISIT DATE: 02/18/2022
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LPA observed the Mandatory Postings on Door to Hallway. Mandatory Posting Requirements: License, Emergency Disaster Plan, and Notification of Parents Rights Poster. Fire Clearance was received on February 7th, 2022.

LPA will recommend, Large Family Child Care License as of today, 2/18/22.

Copy of this report was emailed to the licensee. Signed copy of this report will be kept in the facility file and made available for public review. Desk Duty is available Monday through Friday between 8:00 AM - 5:00 PM at (650) 266-8800. Website for forms and Regulations: www.cdss.ca.gov
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2022
LIC809 (FAS) - (06/04)
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