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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004947
Report Date: 10/06/2022
Date Signed: 10/06/2022 11:46:41 AM

Document Has Been Signed on 10/06/2022 11:46 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:LOI, ANGELLAFACILITY NUMBER:
414004947
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
10/06/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Angella LoiTIME COMPLETED:
12:00 PM
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On October 6, 2022 at approximately 8:15am, Licensing Program Analyst (LPA) Catrina Quimbo conducted a scheduled, pre-licensing inspection. LPA met with applicant, Angella "Angelia" Loi, and explained the purpose of the inspection. Present during LPA's visit included applicant's partner and applicant's mother in law.

Applicant submitted a family child care home application to department August 29, 2022. Applicant lives in the home with applicant's partner and mother in law. Applicant's partner owns the home and leases space to applicant. Proof of control of property was provided.

With applicant, LPA inspected the home for health and safety hazards. Applicant plans to operate Monday to Friday from 7:30am to 5:30pm. Applicant plans to care for children from birth to 4 years old. The home is a single-level home that consists of two bedrooms, 1 bathroom, living room, kitchen, sun room (main classroom), backyard, additional living space in backyard, and garage. The DAY CARE AREAS are the main classroom, bathroom #1, bedroom #2 (napping room only) and backyard. The OFF LIMIT AREAS are the kitchen (pass through only), living room, master bedroom, additional living space in backyard and garage. All off limit areas are properly barricaded with child safety door handles, child safety gates, and/or locked doors. Applicant was notified any off limit areas are not to be used as a day care area without prior approval from department.

Additional living space in backyard is leased to additional tenant. Applicant is aware all adults living on property must have fingerprint clearance prior to initial presence in the home.

Enrolled families are to enter the home through the side gate, located on the right side of the garage, which will be the main entrance for the family child care home.

LPA observed the entire home to be clean and safe. Home is equipped with a fully charged fire extinguisher and multiple first aid kits. The main classroom is equipped with a dual, working smoke and carbon monoxide detector. Applicant uses a designated cell phone and is aware the cell phone must stay within the home during the day care hours.
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SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE: DATE: 10/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/06/2022
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: LOI, ANGELLA
FACILITY NUMBER: 414004947
VISIT DATE: 10/06/2022
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The main classroom has age appropriate toys and equipment available for the children in care. LPA observed electrical outlets in day care areas are made inaccessible with child safety covers and/or blocked by furniture. Home and main classroom have garbage cans with tight fitting lids. All poisons, chemicals and hazardous materials are stored inaccessible behind child safety locked closets and/or located in home's high shelves.

The entire backyard is enclosed with an at least 5 ft. high fence. Backyard includes garden, play area and sitting area. LPA observed poles and other sharp objects located in backyard to be properly padded. Portion of backyard flooring is appropriately padded and cushioned with artificial turf.

Applicant was reminded baby walkers, bouncers, jumpers and any other similar items are not to be used for children in care. Applicant plans to provide sleeping cots and cribs for enrolled children in care. Safe sleep regulations and sanitization were discussed. LPA reminded applicant emergency disaster drills are to be conducted and documented at least once every six months.

Applicant's discipline policy will be through a "calming corner" to help child relax. Applicant will then talk to and redirect child. The designated isolation area will be in the main classroom, separate from other children in care. Applicant plans to provide a food service. Food storage, preparation and sanitization was discussed.

Applicant completed their CPR and First Aid training 09/11/2022. LPA reminded applicant CPR and First Aid training must be renewed every two years. Applicant has proof of required immunizations on file and has completed the Mandated Reporter training on 09/14/2022. Applicant is aware Mandated Reporter training must be renewed every two years by applicant and all staff hired.

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

DATE: 10/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2022
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: LOI, ANGELLA
FACILITY NUMBER: 414004947
VISIT DATE: 10/06/2022
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Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

LPA discussed the safe sleep regulations with applicant 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 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.

LPA reviewed with applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

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

Prior to recommended licensure, following must be completed:
-Posting of Notification of Parents Rights (PUB394).
-Fingerprint clearance for all adults living on the property.
-Installation of child safety gate to living room.

Exit interview conducted and report was reviewed with the applicant, Angella "Angelia" Loi.
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2022
LIC809 (FAS) - (06/04)
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