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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004868
Report Date: 01/24/2022
Date Signed: 01/24/2022 12:13:03 PM

Document Has Been Signed on 01/24/2022 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:SALDIVAR, YULYFACILITY NUMBER:
414004868
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
01/24/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Yuly SaldivarTIME COMPLETED:
01:15 PM
NARRATIVE
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On January 24 2022, Licensing Program Analyst (LPA) Kaur met with applicant Yuly Saldivar, for an announced pre-licensing inspection. The Applicant's parents owns this house. Parents live in different unit. The home resident is applicant, her husband and her son. The entire house is inspected for health and safety hazards. Days and operations are Monday – Friday from 7:30 AM – 4:30PM.
LPA and the Applicant inspected the entire home for Health and Safety Hazards. The house is 2 bedroom 2 bath with living room. Daycare areas are living room, bathroom and backyard. Off-limit areas upstairs bedrooms, kitchen and garage. Per Applicants, all toxic or dangerous chemicals are stored in a cabinet in the kitchen in the off-limit area, making them inaccessible to children. The use of baby-gate barricades all off-limit areas.
Per Applicant, there are no firearms, weapons in the home. The isolation area for sick/ill children will be corner of living area. The house has multiple smoke alarms & carbon monoxide combination detectors. There are sufficient age-appropriate toys, furniture, and napping equipment in the daycare. The Applicant stated that the facility would be providing breakfast, lunch, 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. Licensee has pet(dog) but will be off limit during day care hours.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Harsimran Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 01/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/24/2022
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: SALDIVAR, YULY
FACILITY NUMBER: 414004868
VISIT DATE: 01/24/2022
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Posting Parent's Rights and the Emergency Disaster Plan was reviewed with the Applicant during the inspection. 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 they received it. LPA also discussed with the Licensee the self-assessment guide and provided Technical Assistance. Face covering protocol, handwashing guidelines, hygiene, arrival procedures, and health screening were discussed.
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. LPA discussed the safe sleep regulations with the Applicant and discussed the Child Care Licensing Safe Sleep webpage https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed the Applicant 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.
This facility plans to provide Incidental Medical Services – IMS. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Harsimran Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2022
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: SALDIVAR, YULY
FACILITY NUMBER: 414004868
VISIT DATE: 01/24/2022
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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.


Prior to licensure, the following issue must be addressed.
- Fingerprint clearance for applicant and family members.

The report was reviewed and signed by Applicant. Today's report, 1/24/2022, will be sent to the applicants' email at Saldivaryuly@yahoo.com by the close of business on 1/24/22. Confirmation of receipt is required.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Harsimran Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2022
LIC809 (FAS) - (06/04)
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