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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005383
Report Date: 10/28/2021
Date Signed: 10/29/2021 07:48:40 AM

Document Has Been Signed on 10/29/2021 07:48 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:DUQUE, KARINA & GALEANA, VICENTEFACILITY NUMBER:
214005383
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
10/28/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
03:10 PM
MET WITH:Karina DuqueTIME COMPLETED:
05:10 PM
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On 10/28/21 at 3:10 pm., Licensing Program Analyst (LPA), Farhan Bashir-Tariq arrived at the facility above unannounced to conduct a case management inspection and met with Licensee, Karina Duque. Purpose of inspection was explained and was to inspect the home for capacity increase request. There were six children (5 PreK, 1 Infant) present today with Licensee. Licensee is operating within the capacity and is following staff child ratio on this day. LPA verified the background check clearance of the adults working or living in the home. Licensee rents the home, which is a three bed room and two -bathroom single family house. Licensee lives with husband and two children. Licensee’s husband is also a co-licensee. Days and hours ours of operation are: M-F, 8:30AM – 5:30PM. Licensee provides breakfast, lunch and two snacks. Licensee is part of food program. Day Care areas: level one: living room/play area, bathroom #1 and back yard, level two: play area. Off Limit areas: Bedroom #1 on level one, kitchen on level 2, and entire level 3. This house is located at the back of house no 17. Access to this house is through a side ally situated at the left side of house no 17. This house was previously numbered 17-1/2. City have now changed the number to 19. LPA obtained the paperwork from Licensee indicating the changes with the capacity increase application.

LPA and Licensee inspected the entire day care area for Health and Safety hazards. LPA observed that off limit areas were properly barricaded and made inaccessible to the children in care. There was a carbon monoxide detector and a smoke detector in the home. LPA performed the tests to check the functionality of the detectors. A fire extinguisher of size 2A10BC or bigger and a working telephone was also available in the home. First Aid kit is fully stocked and accessible. Per Licensee, there are no firearms or weapons in the home. Licensee states, there are no bodies of water. Licensee states that there are two dogs in the home. Dogs are vaccinated and kept on level three during child care hours. LPA observed that the house is in good repair and free of hazards with proper temperature and ventilation. Bathroom cabinets have been secured with child safety locks. Hand washing posters were observed in bathroom. LPA observed that there is a variety of age appropriate toys, books, arts, puzzles and other learning material available in the home for the children in care. Electric outlets, in the day care area were secured with child safety covers. Per Licensee, Discipline policy is redirection or communication.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Farhan Bashir-Tariq
LICENSING EVALUATOR SIGNATURE: DATE: 10/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/28/2021
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: DUQUE, KARINA & GALEANA, VICENTE
FACILITY NUMBER: 214005383
VISIT DATE: 10/28/2021
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Children usually nap in the play area on level one. Back yard is used as main child care area. Back yard was fully fenced all around. Back yard had play structures, tables, books, chairs available for children. Access to back yard was through the back door located at the left side of property. There was also a baby gate placed at back yard entrance to make it inaccessible to children. Both Licensee and her husband have current and valid CPR and First Aid cards expiring in November 2022. LPA reminded Licensee to conduct and log fire an emergency drill at least once every six months. Licensee was observed to be wearing mask around children. COVID 19 poster, masks, cleaning wipes and sanitizers were available in the home. Emergency kits were also available. Capacity and ratio limits for a large family child care home was discussed. Capacity handout was emailed to Licensee.

Incidental Medical Services (IMS) policy was discussed. Licensee doesn’t have any child on medication at present. 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 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

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 that all adults 18 and over living or working in the home, 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.

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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Farhan Bashir-Tariq
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021
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: DUQUE, KARINA & GALEANA, VICENTE
FACILITY NUMBER: 214005383
VISIT DATE: 10/28/2021
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LPA reminded Licensee , as of January 1, 2018, all staff is required to complete Mandated Child Abuse Reporter Training (AB1207) every two years. The training can be obtained online at www.mandatedreporterca.com. Per Licensee, she does not have a training certificate as training was only available in English previously and not in Spanish. LPA informed Licensee that training is now available both in English and Spanish. Licensee shall complete the training and send a copy of her certificate to Licensing. LPA encouraged the Licensee to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. Fire clearance was approved and received from San Rafael Fire Department.

Large Family Child Care Home License is recommended for approval and will be effective as of today, 10/28/21.

An exit interview was conducted. This report and rights to comment and appeal were discussed with Licensee. This report must be available in the facility for public review. Notice of site visit was given and must remain posted for 30 days from today's visit. Licensee was advised for any additional questions to call Office, M-F, 8AM-5PM at 650-266-8800. For Rules and Regulations, visit the Website: www.cdss.ca.gov



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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Farhan Bashir-Tariq
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021
LIC809 (FAS) - (06/04)
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