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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004848
Report Date: 01/27/2022
Date Signed: 01/27/2022 04:16:07 PM

Document Has Been Signed on 01/27/2022 04:16 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:SOUSA, FRANCIELE LOPES DEFACILITY NUMBER:
414004848
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
01/27/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Franciele Sousa, Gabriel SantosTIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Andrea Medlin met with applicants for this prelicensing visit. Purpose of visit explained. Applicant plans to operate the daycare: Monday-Friday 7:30AM-5:30PM. Applicant states she and husband are only ones who reside in the home. The home is rented and control of property documents are reviewed and on file. Applicant advised that any person 18 years of age or older who lives here, or provides any care and supervision to daycare children, shall have criminal record clearance on file. The entire home is inspected for health and safety hazards. This is a two level home. On the first level: daycare room, storage room, garage, entryway/hallway, and one bathroom. On the second level: three bedrooms, two bathrooms, living room, dining room/kitchen, office. The daycare areas used will be: on the lower level, daycare designated room, bathroom, entryway, and gated off area in backyard.The second level is off limits with exception that the living room area may be used for backup napping with supervision. The home has smoke detectors, fire extinguishers, and carbon monoxide (CO) detectors. First aid kit/supplies are available. Applicant will use a separated area for isolation of ill/sick children until picked up by parent/guardian. Per applicant, there are no pets and no firearms or weapons in the home. No pools, spas, hot tubs, fish ponds, or similar bodies of water are present. Per applicant, they plan to purchase liability insurance for the child care. There are sufficient, age appropriate toys, and children's equipment available. Bathroom is clean and hazardous materials are inaccessible to children. Applicants advised to conduct emergency disaster drills at least once every six months and log the date and time of the drill.



(continued on next page 809-C)
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Andrea Medlin
LICENSING EVALUATOR SIGNATURE: DATE: 01/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/27/2022
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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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: SOUSA, FRANCIELE LOPES DE
FACILITY NUMBER: 414004848
VISIT DATE: 01/27/2022
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If applicant provides care to the 7th and 8th child, who must be school aged, parent notification and landlord consent is required. The following is required to be posted in an accessible location in view of parents: Emergency Disaster Plan (LIC 610), Parent's Rights (LIC 995A), and License (once received).

This home meets the licensing requirements of a Small Family Child Care Home (FCCH) today and licensure is recommended and approved as of today, 1/27/2022.

This report is reviewed with applicants and a copy of this report must be made available for public review upon request.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Andrea Medlin
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2022
LIC809 (FAS) - (06/04)
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