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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004876
Report Date: 03/28/2022
Date Signed: 03/28/2022 12:28:56 PM

Document Has Been Signed on 03/28/2022 12:28 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:LOPEZ GUZMAN, DAISY N.FACILITY NUMBER:
414004876
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
03/28/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Daisy Lopez Guzman TIME COMPLETED:
12:40 PM
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On 3/28/2022 at 9:20A.M., Licensing Program Analyst (LPA), Luis J. Gomez met with Applicant, Daisy Lopez Guzman for an announced, prelicensing inspection. Purpose of inspection was explained. Present during inspection was the Applicant and one Adult Occupant (Son). Home is a 3 bedroom, 2 bathroom, one level townhouse. Days and hours of operations are: Monday- Friday, 8:00 A.M., to 5:00 P.M. Day-care Areas are: Living Room, Playroom (Garage Area #1), Bathroom #1 and the Outdoor Play Area. Off-limit Area are: Bedroom #1, Bedroom #2, Bedroom #3, Bathroom #2, Garage Area #2, Garage Area #3/ Studio Unit, Kitchen, Dining Room and Laundry Area. LPA inspected home, indoors and outdoors, with applicant for health and safety hazards.

At 9:30A.M., the following was observed: Day-care areas were clean and orderly and equipped with age-appropriate toys, books and supplies. Playthings and furniture inspected were in good repair. Area rugs had been installed for added safety. Playroom had child size tables and chairs for snack and activities. For napping services, LPA observed several cleanable mats stored in facility playroom. Bathroom fixtures, located in bathroom #1, were in proper operating condition. Bathroom #1 was maintained clean with safety locks installed on accessible cabinet doors. Home was the proper temperate with ventilation and lighting in each room. LPA observed all accessible electrical outlets had been covered. Per Applicant, off-limit areas of the home will remain locked during operating hours. Home had a functioning cell phone, smoke/ carbon monoxide detector combo and fully changed fire extinguisher (3A:40:BC). Per Applicant, isolation of an ill child will take place in the facility living room. All detergents, cleaning compounds and other items which could pose a danger had been stored in off-limit area. Per licensee, home does not have any no guns or weapons.

At 9:50A.M., LPA inspected the Outdoor Play Area. Scooters and outdoor playthings inspected were in good repair. Area was completely enclosed with tall shrubbery and fencing along the street side. Home does not have pools, fishponds, jacuzzi or any other bodies of water on the premises. (REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 03/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/28/2022
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 3
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: LOPEZ GUZMAN, DAISY N.
FACILITY NUMBER: 414004876
VISIT DATE: 03/28/2022
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(PAGE 2)

At 10:00A.M., LPA reviewed required forms with the applicant. LPA and applicant reviewed the LIC311D, Records to Keep in Your Family Child Care Home, children’s forms/ records, facility forms, and information to be posted. Applicant's CPR/ 1st Aid certification was current, expiring on 2/2024. Per Applicant, she plans to provide all daily snacks and meals.

Applicant was informed that the Department must be notified prior to the use of any off-limits areas. LPA and the applicant discussed licensing regulations and the capacity requirements. Any children under 10 years of age will be counted in the capacity. Applicant was advised that all food containers brought from home must be properly stored and labelled. Applicant understands the required emergency disaster drills are to be conducted and documented every six months. Applicant understands that the use baby walkers, bouncers, jumpers and similar items are not to be used for children in care. Smoking is prohibited inside a Family Childcare Home.

Applicant was informed 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.

Applicant was informed that all adults 18 years and over living or working in the home, including employee and volunteers, must obtain criminal 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.



LPA discussed the safe sleep regulations with licensee and discussed Child Care Licensing Safe Sleep Web page at:https://www.cdss.ca.gov/inforesource/child-care-licesning/public-information-and-resources/safe-sleep as an additional resource. LPA informed licensee of the importance of checking for recalled infant devices on United States consumer Product Safety Commission (CPSC) website at http://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. (REFER TO 809C, FOR CONT.)
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2022
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: LOPEZ GUZMAN, DAISY N.
FACILITY NUMBER: 414004876
VISIT DATE: 03/28/2022
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(PAGE 3)
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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important communication platform.

To receive important licensed- related information to licensed facilities, visit the CCLD important information website at https://www.cdss.ca.gov/infosource/community-care-licensing/subscribe and select the child care option to receive email communication.

During today's inspection applicant submitted the following documents: Updated Lease Agreement, LIC 9149 and Immunization record.

Prior to recommendation for licensure, applicant must complete the following:

-Remove all hazardous plants from the outdoor play area

-Post all required postings in a visible location

-Receive criminal record clearance for all adults in the home

-Submit current mandated reporter training certification (AB1207)

-Additional review from department management

Exit interview was conducted with applicant, Daisy Lopez Guzman and copy of this report was provided. This report will be kept in the facility file and made available for public review upon request. Desk Duty is available Monday through Friday between 8AM - 5PM at (650) 266 -8800.

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2022
LIC809 (FAS) - (06/04)
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