434412499-9-12-2022-52-CC-SDOO-CJ7SHV-20220912135410

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434412499
Report Date: 09/12/2022
Date Signed: 09/12/2022 01:54:28 PM

Document Has Been Signed on 09/12/2022 01:54 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	ALVAREZ, YISSELA		FACILITY NUMBER:	434412499
ADMINISTRATOR:	ALVAREZ, YISSELA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 331-0770
CITY:	PALO ALTO	STATE: CA	ZIP CODE:	94301
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 1	DATE:	09/12/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:20 AM
MET WITH:	Yissela Alvarez		TIME COMPLETED:	01:55 PM

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 Monday 09/12/2022 at approximately 11:20AM, Licensing Program Analyst (LPA) Sabina Dodoo met with licensee Yissela Alvarez for an UNANNOUNCED ANNUAL REQUIRED INSPECTION for a Large Family Child Care Home. Present for the inspection were the Licensee who is fingerprint cleared. The total children enrolled are 1 and the census was 1 child at the time of the inspection. Licensee’s 5 years old daughter is also included in the ratio. The Family Child Care Home is within ratio. The Family Child Care Home was toured to conduct a Health and Safety Inspection. The center currently operates Monday through Friday from 8am to 4:45pm. PHYSICAL PLANT: The Family Child Care Home is a single-story residential home with 3 bedrooms, and 2 bathrooms. There is a detached garage. The entrance of the Family Child Care Home is the main door of the house. The living room has been converted into an activity room. There is one bedroom used as a napping area. LPA observed 4 see through cribs with a changing table in the bedroom. LPA observed a bathroom near the kitchen area that is in operable condition. LPA observed the bulletin board (parent’s rights, emergency disaster plan, earthquake drills, PUB269, and facility license). All hazardous materials and toxins are kept out of reach from children and are not accessible. This Family Child Care Home has one fully charged fire extinguisher 3A-10- 40 BC, multiple smoke detectors and multiple carbon monoxide detectors, a telephone and a fully stocked first aid kits. The furniture around the activity area and outdoor area are all child proof and adequate for children to use. The learning materials are organized, and toys are kept in safety bins and cabinets for easy access for the children. On Limit Areas are: the hallway bedroom(napping area), the living room(activity room), the hallway bathroom by kitchen, and the entire backyard. Off Limit Areas are: the 2 bedrooms, the garage, the kitchen, the dining room, the hallway bathroom by the bedrooms and the driveway.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Sabina Dodoo
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2022

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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: ALVAREZ, YISSELA	FACILITY NUMBER: 434412499
	VISIT DATE: 09/12/2022

NARRATIVE

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FOOD & SNACK: The licensee provides breakfast, lunch, AM snack and PM snack. Licensee provides water. The children bring personal bottles from home.

OUTDOOR: LPA Dodoo observed the outdoor play area which has a small play structure with a slide, a playhouse and a covered sandbox. There is a soft green cushioning material all around the play yard to absorb falls. The outdoor play area is also fenced all around with secured gates. There is no water on the premises and no firearms.

RECORDS: LPA Dodoo reviewed 1 children’s file and 1 staff files and documented them on LIC 857 and LIC 859. A current roster was viewed by LPA. LPA obtained a copy from Licensee. The staff interview was completed with Licensee Yissela Alvarez. Licensee has completed the Health and Safety training and CPR/First Aid is current. Licensee is following the immunization laws and has completed the mandated reporter training. The Licensee has conducted and documented the fire and disaster drills twice a year and the last conducted drill was on August 20th, 2022. All required forms are posted and visible for public view.

Incidental Medical Services (IMS) policy was discussed. This facility does not provide IMS (Incidental Medical Services) to children in care currently. If 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: http://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.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Sabina Dodoo
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2022

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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: ALVAREZ, YISSELA	FACILITY NUMBER: 434412499
	VISIT DATE: 09/12/2022

NARRATIVE

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Licensee was reminded that all adults 18 and over working in Child Care Center, 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 Child Care Center. 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 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.

Licensee was reminded of the responsibility as a mandated reporter and the trainings must be done once every two years as well as CPR/First Aid needs to be renewed every two years and must be EMSA approved. LPA also encouraged licensee to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, as well as all forms can be downloaded. For licensing updates and Quarterly Child Care Distribution email, email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list.

Effective August 1, 2003 California Law requires Child Care licensees to report unusual incidents or injuries to children in care to child’s parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours to the regional office by phone and the written report, LIC 624 within 7 business days.

There are no deficiencies cited during today’s inspection. A notice of site visit was given and must remain posted for 30 days. Exit Interview and staff interview was conducted with Licensee (Yissela Alvarez). A copy of Appeal Rights was provided. This report shall remain on file for the next 3 years.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Sabina Dodoo
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2022

LIC809 (FAS) - (06/04)

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