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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005553
Report Date: 10/14/2021
Date Signed: 10/15/2021 08:44:50 AM

Document Has Been Signed on 10/15/2021 08:44 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:KUHNHAUSEN, KATIA L.FACILITY NUMBER:
214005553
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 3CENSUS: 3DATE:
10/14/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
04:20 PM
MET WITH:Katia KuhnhausenTIME COMPLETED:
06:00 PM
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On 10/14/21 at 04:20 pm., Licensing Program Analyst (LPA), Farhan Bashir-Tariq arrived at the facility above announced to conduct a case management inspection and met with Licensee, Katia Kuhnhausen. Purpose of inspection was explained and was to approve bedroom #1 and #2 to be used for napping. There were three infants 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 adults working or living in the home. Licensee rents the home, which is a three bedroom and two-bathroom house. Hours of operation will be: M-F, 7:30 am- 5:30 pm. Licensee is not providing any meals at this point. Children bring their own food for now. However, Licensee have emergency snack supplies available for children in care. Daycare areas: Living room /Play area, Back yard (only deck area) , Bathroom #2, and Bedroom #1, #2 (napping only). OFF limit areas: Bathroom #1, Bedroom #3, Kitchen, 3 Closets located in hallway and Back yard area beyond the deck point.

LPA and Licensee inspected the entire home for Health and Safety hazards as previously PreLicesing inspection was conducted virtually due to COVID-19 restriction. LPA observed that off limit areas were properly barricaded and made inaccessible to the children in care. There were multiple carbon monoxide detectors and smoke detectors 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 no pets in the home. There is a fire place located 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. Licensee will only use deck area at the back adjacent to kitchen. Licensee have a baby gate available at the site. Licensee is waiting for the gate to be installed at small stairs prior to start using it for children.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Farhan Bashir-Tariq
LICENSING EVALUATOR SIGNATURE: DATE: 10/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/14/2021
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: KUHNHAUSEN, KATIA L.
FACILITY NUMBER: 214005553
VISIT DATE: 10/14/2021
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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. 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.

The following corrections shall be made prior to using the space for children:

1. Baby gate needs to be installed at deck area stairs.

2. Stand-alone mattress in bedroom #2 should be removed and stored away.

3. Extension cord in bedroom #1 should be blocked off

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

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

DATE: 10/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2021
LIC809 (FAS) - (06/04)
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