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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005493
Report Date: 09/17/2021
Date Signed: 09/17/2021 04:31:55 PM

Document Has Been Signed on 09/17/2021 04:31 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:CHAN-ROSADO, NELSY A.FACILITY NUMBER:
214005493
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 1DATE:
09/17/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Nelsy Chan-RosadoTIME COMPLETED:
04:45 PM
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Licensing Program Analyst (LPA), Farhan Bashir-Tariq arrived at the facility above unannounced to conduct a required one-year inspection and met with Licensee, Nelsy Chan-Rosado. Purpose of inspection was explained. There was one infant present today with Licensee. All adults living or working in the home have fingerprints clearance on file. Licensee is operating within the capacity and ratio limits as of today 9/17/21. Hours of operation are: M-F, 7:30 AM - 4:00 PM. Licensee provides breakfast, lunch and two snacks. This is a two bedroom and one-bathroom apartment. Day Care areas: Living room, Dining area and Bathroom Off limit areas: Bedroom #1, Bedroom #2 and Garage.

LPA and Licensee inspected the entire day care area for health and safety hazards. All off limit areas were properly barricaded and made inaccessible to the children in care. Licensee states that there is no pool, spa or any other body of water in the home. Licensee states, there are no weapons or firearms in the home. Licensee states, she has a small cat in the home. The house is in good repair and free of hazards with proper temperature and ventilation. There is a carbon monoxide detector, a smoke detector, a fully charged fire extinguisher and a working telephone available in the home. There is a First Aid kit available in the home. Licensee has a current and valid CPR card expiring in May 2023.


LPA reviewed facility records including two children's files. Licensee only has two children enrolled in the program at present. Children's files were current and complete. LPA reviewed the identification and emergency information form for every child for proper names and numbers filled.

Incidental Medical Services (IMS) policy was discussed. 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
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Farhan Bashir-Tariq
LICENSING EVALUATOR SIGNATURE: DATE: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/17/2021
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: CHAN-ROSADO, NELSY A.
FACILITY NUMBER: 214005493
VISIT DATE: 09/17/2021
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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. 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. LPA reviewed that certificates were present for both licensees and a helper.


> No deficiencies were cited today under Title 22 Division 12 of the California Code of Regulations.

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 shall be 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: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021
LIC809 (FAS) - (06/04)
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