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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005427
Report Date: 12/14/2022
Date Signed: 12/14/2022 03:20:56 PM

Document Has Been Signed on 12/14/2022 03:20 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:CRUZ, LEILA M.FACILITY NUMBER:
214005427
ADMINISTRATOR:CRUZ, LEILA M.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 879-7188
CITY:MILL VALLEYSTATE: CAZIP CODE:
94941
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
12/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:02 PM
MET WITH:Ivonne HernandezTIME COMPLETED:
03:35 PM
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On 12/14/2022, Licensing Program Analyst (LPA), Hanson Leong, made an unannounced annual visit to the Leila Cruz’s day-care facility. The LPA was granted entry by the Licensee’s assistant, Ivonne Hernandez. The LPA explained the purpose of the visit to the licensee’s assistant. Guardian, the department's system for conducting background checks, has confirmed that all the individuals listed on the facility’s roster have been granted permission to work or be present in a childcare facility. The LPA observed the licensee’s two assistants supervising four infants and six preschool children. Children's capacity and ratio requirements were observed to be in compliance. During the visit, the licensee was not present in the facility.

Day-care Area(s): Living room, Bathroom (hallway), Bedroom (by the front door), Licensee daughter's bedroom, Front yard, and Backyard.

Off Limit Area(s): Licensee's own bedroom and a separate building in the back. All off-limit area(s) are secured with a locked door or a safety gate. The licensee understands that off-limits areas may not be used for childcare during business hours.

The LPA and the licensee’s assistant both performed careful inspections of the day-care facility to look for any potential health and safety hazards. Toys and equipment that are suitable for children of the proper age range are provided at the day-care. The building has sufficient lighting and ventilation, and it is free of any defects or conditions that could put the children in its care in risk. The facility is equipped with a first aid kit that is completely loaded with everything that is required for the treatment of injuries. The day-care facility is equipped with a smoke detector, a carbon monoxide detector, and a fire extinguisher that is always ready for use. Every garbage can and power outlet has been covered. Products for cleaning and washing, detergents, and any other materials that could put children in danger are stored out of their reach. The LPA did not find any walkers, bouncers, or other comparable objects during its inspection.

There are reportedly no firearms or other weapons on the premises, as stated by the licensee’s assistant.


*** See Page 2 for continuation***
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE: DATE: 12/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/14/2022
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 2
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: CRUZ, LEILA M.
FACILITY NUMBER: 214005427
VISIT DATE: 12/14/2022
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Continued, Page 2
The LPA found that the facility did not have any pools, spas, or other types of bodies of water of any kind.

The LPA observed that the facility had posted all the required forms, including the facility license, Notification of Parental Rights, Earthquake Preparedness Checklist, and Notification of Personal Rights. The licensee is aware that smoking is not permitted in a family childcare facility.

The LPA reviewed the records of five children. All required forms were in the children’s’ file.

The LPA reviewed the records of the licensee's two assistants. All required forms were in the files of the licensee's two assistants. A review of the licensee's training records reveals that the licensee’s two assistants are up to date with their Pediatric First Aid / CPR certifications.

According to the licensee's assistant, the facility satisfies the requirements by carrying out simulations of fire and earthquake drills twice a year, as well as by documenting their results.

The following reminders were discussed with the licensee's assistant:


1. 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.
2. Incidental Medical Services (IMS) policy
3. As of January 1, 2018, all staff must complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.
4. Regulations for safe sleeping in accordance with the Health and Safety Code.
5. Checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/

No deficiencies were issued today

A copy of this report, and the “Notice of Site Visit” were given to the licensee's assistant.

A “Notice of Site Visit” must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

An exit interview was conducted, and the report was reviewed with the Licensee's assistant, Ivonne Hernandez

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE:

DATE: 12/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2022
LIC809 (FAS) - (06/04)
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