414004855-12-7-2021-05-CC-LGOZ-C9GW47-20211207155704

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004855
Report Date: 12/07/2021
Date Signed: 12/07/2021 03:57:11 PM

Document Has Been Signed on 12/07/2021 03:57 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:	GONCALVES DE SOUZA, ELEANDRA		FACILITY NUMBER:	414004855
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	12/07/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	01:05 PM
MET WITH:	Eleandra Goncalves de Souza		TIME COMPLETED:	04:10 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 12/7/2021 at 1:05A.M., Licensing Program Analyst (LPA), Luis J. Gomez met with Applicant, Eleandra Goncalves de Souza for a schedule Prelicensing inspection at the facility. Applicant's COVID-19 prevention and mitigation measures were also reviewed during today's inspection. Present was the applicant and no children. Applicant rents the home, which is a two bedroom, two bathroom, two story townhouse. Day and hours of operation are: Monday – Friday 7:30A.M. – 5:00P.M. Daycare Area: Lower Level: Playroom (Living Room), Napping Area, Bathroom #1, Hallway (Pass Through Only) and Outdoor Patio Area. Off-limit Area: Lower Level: Kitchen, Garage, Upper Level: Bedroom #1, Bedroom #2 and Bathroom #3. LPA inspected entire home, Inside and outside, with applicant for health and safety hazards. At 1:10P.M., LPA observed the following: Day-care area was clean and orderly. Playroom was equipped with variety of age- appropriate toys, books and blocks for the children. Furniture and playthings inspected were in good repair. Playroom had child size tables and chairs for snack and other activities. Playroom had children storage cubbies along the wall. Large shelves had been properly anchored. Child safety gates have been installed on staircase in the entry way. Fireplace in playroom was properly barricaded. Applicant installed removable padded squares for added safety. For napping services, applicant has cleanable napping cots and several play pens. Bathroom #1 was in operating condition with adequate supplies for the children. All outlets and trash bins have been properly covered. Accessible cabinets and drawers in kitchen were made inaccessible. Detergents and cleaning compounds were stored in the off-limit areas. Home was the proper temperature with adequate ventilation. Home had functioning cell phone, smoke detector/ carbon monoxide detector combo, and two fire extinguishers (2A:10BC), located in the kitchen and playroom. Safety lock had been installed in washing machine unit in the hallway. At 1:30P.M. LPA inspected the Outdoor Patio Area. Patio area is completely enclosed with tall fencing. Applicant has installed turf and all accessible gates are properly locked. Children’s outdoor playthings were in good repair. There were no pools, jacuzzis, fish pods or any other bodies of water on the property. (REFER TO 809-C, FOR CONT.)

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2021

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: GONCALVES DE SOUZA, ELEANDRA	FACILITY NUMBER: 414004855
	VISIT DATE: 12/07/2021

NARRATIVE

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Per applicant, there are no guns or weapons stored in the home. Isolation area for an ill child will be in the playroom. Applicant was informed that the Department must be notified prior to the use of any off-limits area. Applicant’s CPR/ first aid certification was current, expiring: 7/13/2023. Applicant’s Mandated Reporter Training was current, expiring: 1/8/2022. Applicant and LPA discussed licensing regulations and the capacity requirements. Any children under 10 years of age will be counted in the capacity. Applicant stated she plans to provide a daily snack and lunch for children. Applicant was advised that all food containers brought from home must be properly stored and labelled. Applicant understands emergency disaster drills are to be conducted every six months and documented. Applicant understands that baby walkers, bouncers, and excersaucers are not allowed. Smoking is prohibited inside a Family Childcare Home.

Applicant was informed that all adults, 18 years and older who live in the home or assist with children, must have their criminal record clearance and association prior to having contact with day-care children. For background clearance transfers, applicant can submit the LIC 9182 with copy of CA DL or CA ID. Failure to comply could result in an immediate civil penalty of $100.00 per day. Applicant was reminded that as of September 1, 2016, a person may not be employed or volunteer at a childcare facility, unless he or she has been immunized for influenza, pertussis and measles or qualifies for an exemption pursuant to Health and Safety Code 1596.7995 and 1597.662.

Incidental Medical Services (IMS) was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding Americans with Disabilities Act (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 publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: www.ada.gov/childqanda.htm.

Mandated Reporter Training is available on the CCLD website. Training must be completed every two years by the applicant and all facility staff. Training can be taken online: www.mandaterreporterca.com. (REFER TO 809-C, FOR CONT.)

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2021

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: GONCALVES DE SOUZA, ELEANDRA	FACILITY NUMBER: 414004855
	VISIT DATE: 12/07/2021

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Applicant was informed about the Provider Information Notices located on the CCLD website. Safe Sleep handout was discussed. Applicant understands Individual Safe Sleep Plans (LIC9227) shall be completed for infants up to 12 months of age and maintained in the infant’s file.

Applicant can also email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

During inspection applicant submitted: COVID-19 Self-Assessment, LIC9149, LIC9217 and LIC9182.

Prior to recommended for licensure, applicant must complete the following:
-Post all required forms including: LIC610A, PUB394 and LIC9148
-Install safety gate in Napping Area
-Install functioning lamp in Playroom Area
-Adjust folded turf in Patio Area

Copy of this report was provided to the applicant. This report will be kept in the facility file and will be made available for public review upon request. Desk Duty Line is available Monday through Friday between 8 AM - 5 PM at (650) 266-8800.

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2021

LIC809 (FAS) - (06/04)

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