414005166-10-17-2024-05-CC-LTMO-DA5PRN-20241017113301

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414005166
Report Date: 10/17/2024
Date Signed: 10/17/2024 11:33:13 AM

Document Has Been Signed on 10/17/2024 11:33 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	VAZQUEZ, MARIA, DIAZ, JOSE, RAMOS, GRACIELA		FACILITY NUMBER:	414005166
ADMINISTRATOR/ DIRECTOR:	VAZQUA, M, DIAZ, J, RAMOS,		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 284-9261
CITY:	EAST PALO ALTO	STATE: CA	ZIP CODE:	94303
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	10/17/2024
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:30 AM
MET WITH:	Applicant, Maria Isabel Vazquez		TIME VISIT/ INSPECTION COMPLETED:	11:50 AM

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 October 17th, 20224, Licensing Program Analyst (LPA), Tapia-Mandujano conducted a scheduled Pre-Licensing inspection this day and met with applicant, Maria Isabel Vazquez. Purpose of the inspection was explained. Applicant has relocated from Facility #414004982 to this current location. Applicant has been previously licensed at this address under Facility #414004555. Present in the home today are applicant, and applicant’s adult son. All adults living in the home have obtained fingerprint clearance and are associated to this new facility. During office meeting that was conducted under Facility #414004982, applicant, Maria Isabel Vazquez stated that she will be the sole applicant for facility. Applicant submitted an updated LIC 279 reflecting the change. Department received fire clearance from Menlo Park Fire Department on 10/10/24. Applicant rents home, which is a four bedroom two in a half bathroom single-level house with front and backyard. Applicant lives in home with adult husband, parents, and two sons. The hours of operation are Monday-Friday from 8am-4pm. Daycare areas area: Living Room, Dining Room, Hallway area between dining area leading to the kitchen, Bathroom #1, Bedroom #3, Backyard with Deck, Side yard (left). OFF limit areas: Kitchen, Bedroom #1, #2, and #4, Half-Bathroom (inside Bedroom #1), Bathroom #2 (inside of Bedroom #2), Laundry Room, Side Yard (right), and front yard/driveway. All off-limit areas are properly barricaded. LPA and applicant inspected entire home for Health and Safety Hazards. Applicant is still setting up the day care areas. LPA observed the following at the time of the inspection: Day-care is clean, orderly with a variety of age-appropriate toys for the children. All furniture inspected is in good repair. The applicant has a fully stocked First Aid kit and thermometer. The home has no pools or bodies of water in the home. LPA reminded applicant about water safety. Home has a fireplace that still needs to be properly barricaded. Applicant has no pets. Per applicant, there are no guns or weapons in the home. The home has age-appropriate equipment available for children in care. Applicant was reminded baby walkers, bouncers, jumpers, and any other similar items are to not be used for children in care. Discipline policy was discussed. Isolation area for sick child will be by the front door side entrance. Applicant will serve breakfast, lunch, and two snacks. Continued on Page 2...

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2024

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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: VAZQUEZ, MARIA, DIAZ, JOSE, RAMOS, GRACIELA	FACILITY NUMBER: 414005166
	VISIT DATE: 10/17/2024

NARRATIVE

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The home has sufficient lighting and ventilation. Applicant states they will conduct an emergency drill once every six months and log drills. Applicant's CPR & First Aid expire on 05/2026. Mandated Reporter Training Certificate for applicant has since expired.

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, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

APPLICANT WILL WAIT UNTIL FACILITY OPENS TO DETERMINE IMS NEEDS:
Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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) or (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.

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. Entrance Checklist was provided to the applicant. During today's inspection, LPA received the following Documents: LIC 279, LIC 279B, applicant's CPR & First Aid Certificate, applicants annual flu, and Lease Agreement that is expired.

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.

On this date, 10/02/2024, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

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SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2024

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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: VAZQUEZ, MARIA, DIAZ, JOSE, RAMOS, GRACIELA	FACILITY NUMBER: 414005166
	VISIT DATE: 10/17/2024

NARRATIVE

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Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Prior for approval of Large Family Child Care home, applicant must submit proof of the following items:
*Applicants mandated reporter training renewed
*Tuberculosis immunization for all adults living in the home
*Updated Lease Agreement
*All Day care areas must be fully set up and free of any potential hazards
*Fireplace must be more secure
*Cables by desk fully secured
*Physical and written proof that applicant has been fully moved out from previous location

Exit interview conducted and report was reviewed and translated into Spanish with the applicant, Maria Isabel Vazquez.

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 platforms.

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.

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2024

LIC809 (FAS) - (06/04)

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