<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005540
Report Date: 09/21/2021
Date Signed: 09/21/2021 01:46:27 PM

Document Has Been Signed on 09/21/2021 01:46 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:MORALES, EDINAFACILITY NUMBER:
214005540
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
09/21/2021
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Edina MoralesTIME COMPLETED:
02:10 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 9/21/21 at 11:40 am., Licensing Program Analyst (LPA), Farhan Bashir-Tariq arrived at the facility to conduct a scheduled case management inspection. Purpose of inspection was explained and was to inspect the home for capacity increase. There were four children present today with Licensee and her Husband, Jose Almanza. 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 two bed room and one-bathroom single family house. Licensee lives with husband and two children. The hours of operation are: M-F, 7AM – 5:30PM. Licensee provides breakfast, lunch and two snacks. Licensee is part of food program. Day Care areas: Living room, Bathroom, Back yard and Dining area. Off Limit areas: Bedroom #1, Bedroom #2, Kitchen, Laundry area, Closets next to laundry area and One small left side of back yard.

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 four dogs in the home. However, dogs are kept on off limit area during child care hours. A small left side of the back yard is specially designated as dog’s area. Access to this area has been blocked off with a bay gate. There is a fire place available in the living room. Fire place was blocked off with book shelf. 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. Chemicals or poisons were stored in an inaccessible kitchen cabinet. 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 are, have been secured with child protective covers. Per Licensee, Discipline policy is redirection or communication. Back yard was also approved to be used as a licensed child care area. Back yard is fully fenced all around. Artificial grass was installed to prevent any falls or injuries. Fire exit is located on the right side of the back yard.

Page... 1 of 3

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Farhan Bashir-Tariq
LICENSING EVALUATOR SIGNATURE: DATE: 09/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/21/2021
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 3
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: MORALES, EDINA
FACILITY NUMBER: 214005540
VISIT DATE: 09/21/2021
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
26
27
28
29
30
31
32
Both Licensee and Jose have current and valid CPR and First Aid cards expiring in June 2023. LPA remined Licensee to conduct and log fire an emergency drill at least once every six months. Per Licensee’s log, last drill was conducted in June 2021. Mandatory child abuse training certificates were observed for Licensee and Jose, which were taken on 9/30/30 and 9/30/21 respectively. These certificates are valid for two years. Licensee also provided safe sleep log for infants. Licensee was documenting times following the correct procedure as required by Licensing. Staff was observed to be wearing masks 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 were discussed. Capacity handout was emailed to Licensee.

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

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.

Page... 2 of 3

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

DATE: 09/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: MORALES, EDINA
FACILITY NUMBER: 214005540
VISIT DATE: 09/21/2021
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
26
27
28
29
30
31
32
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 encouraged the Licensee to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. Facility can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

Large Family Child Care Home License is approved and will be effective as of today, 09/21/21.

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 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


Page... 3 of 3
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Farhan Bashir-Tariq
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2021
LIC809 (FAS) - (06/04)
Page: 3 of 3