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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005541
Report Date: 04/16/2021
Date Signed: 04/20/2021 04:03:34 PM

Document Has Been Signed on 04/20/2021 04:03 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:SANTOS, CLEUDES O.FACILITY NUMBER:
214005541
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
04/16/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Cleudes SantosTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Haydee Caliboso met with the applicant named Cleudes Santos for a pre-licensing inspection of the home via Facetime. Due to the COVID -19 and current shelter in place orders in the State of California and Marin County, the pre-licensing inspection was conducted via tele-inspection on April 16th, 2021. Today’s inspection included COVID-19 technical assistance, guidance, and support.

The applicant lives in a two-bedroom, one bath duplex home by herself. The home has its own private entrance. The applicant’s son visits the home once a week. The applicant and the applicant’s son have been fingerprint cleared. The hours of operations are Monday through Friday, 8:00AM to 5:00PM, and will provide care for children between 7 months to Kindergarten. Capacity and ratio requirements were discussed and reviewed with the applicant. There is proper lighting and ventilation in the home, a working telephone, fully functioning smoke and carbon monoxide detectors, and a fully charged 2A10BC fire extinguisher. Applicant’s home is clean, orderly, and equipped with age-appropriate toys for children. LPA observed there are no baby walkers, bouncers, or exersaucers used during the hours of care and operations.

Childcare will be provided in these areas: living room area, hallway bathroom, bedroom#1 for napping area, and backyard. The living room and bedroom#1 are free of hazards, and outlets are child proof. The applicant’s unit has its own designated backyard and will be used during hours of operations. The backyard is fenced, and the surface area is cushioned using synthetic grass. All children’s toys are in good working conditions.
Cont. 809 pg.2
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Haydee R Caliboso
LICENSING EVALUATOR SIGNATURE: DATE: 04/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/16/2021
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: SANTOS, CLEUDES O.
FACILITY NUMBER: 214005541
VISIT DATE: 04/16/2021
NARRATIVE
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Off limit areas: garage, laundry area, kitchen and bedroom#2. The kitchen area is gated and will only be used as a passageway only to access the yard. All off limit areas are made inaccessible to children. LPA observed all cabinets and doors have locks and safety latches. All cleaning supplies, detergents, and toxins are stored and locked and made inaccessible to children. Kitchen knives are stored where they are made inaccessible to children. Applicant will provide breakfast, lunch, and snacks daily for the children.

The home has no fireplace. There is no body of water such as a swimming pool, spa, hot tub, or fishpond in the home. The applicant has no pets and no weapons or firearms in the home. First Aid supplies are available. The LPA reviewed and discussed all necessary requirements to administer medical treatment. The applicant will administer medications to children. LPA reviewed and discussed isolation of sick children. Positive redirection will be used for discipline.

All requirements for required postings were discussed such as License/Parent’s Right poster/Emergency Disaster Plan and Earthquake Preparedness checklist. Applicant has all the current required postings in the home that needs to be posted. LPA informed the applicant that emergency drills will be conducted at least once every six months and drills must be properly logged. LPA discussed facility ratios and capacities with the applicant. The applicant was reminded there are no walkers, exersaucers, jumpers, bouncers or any similar items to be used for children in care and shall be made inaccessible. Applicant is advised all adults, 18 years and older living in the home, helper, or assistant must have a criminal record clearance and must be associated to the facility by submitting an LIC 9182 form with a copy of CA Driver's License or CA ID prior to having any contact with children in care.

Applicant was informed that as of September 1, 2016, a person may not be employed or volunteer at a childcare facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.
Cont. 809 pg.3
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Haydee R Caliboso
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2021
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: SANTOS, CLEUDES O.
FACILITY NUMBER: 214005541
VISIT DATE: 04/16/2021
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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.

Applicant was informed about the Provider Information Notices (PINs) on CCLD website. A copy of A Child Care Provider's Guide to Safe Sleep was emailed to the applicant. This report was discussed and explained to the applicant. Records to be maintained in the facility was discussed and reviewed with the applicant. LPA provided a copy of records to use for all children in care. Mandatory Posting Requirements: License, Emergency Disaster Plan, and Notification of Parents Rights Poster. Applicant has completed the www.mandatedreporter.ca.com training and a copy is in the file. LPA discussed the effects of lead exposure with the applicant. Resources and materials were sent through email on 4/16/21. LPA encouraged the applicant to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. Applicant can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

On 4/5/21 LPA Haydee Caliboso emailed FCC self-certification to the applicant. Applicant will need to complete and sign self-certification and returned a copy to LPA Caliboso. A copy will be kept in the applicant’s file. On 4/16/21 LPA discussed with the applicant in order to operate and care for more than six up to eight children at a Small Family Child Care Home a LIC 9149 is needed.

Prior to approval of small family childcare: the applicant shall complete and submit verification of the following:
· Posting requirements and COVID-19 posters are complete and posted.

This report will be kept in the facility file and will be made available for public review upon request. Desk duty is available Monday - Friday, 8:00am - 5:00pm. (650) 266-8800. Website for Forms and Regulations: www.cdss.ca.gov
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Haydee R Caliboso
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2021
LIC809 (FAS) - (06/04)
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