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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004855
Report Date: 11/21/2022
Date Signed: 11/21/2022 11:05:26 AM

Document Has Been Signed on 11/21/2022 11:05 AM - 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, ELEANDRAFACILITY NUMBER:
414004855
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 5CENSUS: 4DATE:
11/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Eleandra Goncalves De SouzaTIME COMPLETED:
11:20 AM
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On November 21, 2022 at approximately 8:45am, Licensing Program Analyst (LPA) Catrina Quimbo, conducted an unannounced, annual inspection. LPA met with licensee, Eleandra Goncalves De Souza, and explained the purpose of the visit. Present during LPA's visit included licensee, licensee's assistant, and 4 enrolled children (4 infants). Facility is operating within capacity limits and ratio during LPA's visit.

Hours of operation are Monday to Friday 7:30am to 5:30pm. Licensee lives in multi-level, single family home. The home includes two bedrooms, two bathrooms, living room, napping area, kitchen, outdoor area, and garage. The DAY CARE AREAS are the living room (main playroom), napping area (lower level), bathroom #1, hallway (pass through only) and outdoor area. The OFF LIMIT AREAS are the kitchen, garage and entire second level of the home. Off limit areas are barricaded with child safety gates and/or locked doors.

At approximately 9:00am, LPA inspected day care areas with licensee. LPA observed home to be in good repair with proper temperature and ventilation. LPA observed electrical outlets in day care areas to be made inaccessible with child safety coves and/or blocked by furniture. Main playroom includes a fireplace that is properly barricaded and made inaccessible with a child safety gate. LPA observed lower shelf cabinets to be made inaccessible with child safety locks.

Home is equipped with a variety of age appropriate toys and equipment that were observed to be clean and in good working condition. LPA observed cleaning supplies, poisons and other chemicals to be made inaccessible, behind child safety locked cabinets, stored on high shelves, and/or stored in off limit areas.

Home has a working carbon monoxide detector, multiple fully charged fire extinguishers, fully stocked first aid kit and a working phone on site. Phone number listed for licensee is current. Per licensee, there are no weapons or firearms in the home.

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SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE: DATE: 11/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/21/2022
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: GONCALVES DE SOUZA, ELEANDRA
FACILITY NUMBER: 414004855
VISIT DATE: 11/21/2022
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There were no pools, spas or bodies of water in the outdoor area. Entire outdoor area is fully enclosed with an at least 5 ft. high fence. LPA observed outdoor area's electrical wiring to be made inaccessible with a safety screen installed. Licensee also appropriately covered and padded fixtures in outdoor area attached to home. Flooring in outdoor area is adequately covered with artificial turf that is in good working condition.

LPA reviewed 5 enrolled children's files. Children's files have a record of emergency identification information on file. LPA also reviewed licensee and assistant's files, which were complete. Both licensee and assistant have a current Pediatric First Aid/CPR certification and Mandated Reporter training certificates. Licensee's CPR certification will expire 07/2023 and Mandated Reporter certificate will expire 01/2024. Licensee is aware CPR and Mandated Reporter certification must be renewed every two years.

Last emergency disaster drill was conducted 09/01/2022. Emergency drills are conducted at least once every six months and are properly logged. LPA observed all licensing documentation posted and available for review near front door entrance.

Incidental Medical Services (IMS) policy 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 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.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

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SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2022
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: 11/21/2022
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LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

No deficiencies were cited today under CCR, Title 22, Div. 12.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee, Eleandra Goncalves De Souza.
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2022
LIC809 (FAS) - (06/04)
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