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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004090
Report Date: 06/04/2021
Date Signed: 06/04/2021 03:17:46 PM

Document Has Been Signed on 06/04/2021 03:17 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:LAMA, NADIA V.FACILITY NUMBER:
384004090
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 1DATE:
06/04/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Licensee, Nadia LamaTIME COMPLETED:
03:25 PM
NARRATIVE
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On 6/4/2021 at 12:45P.M. Licensing Program Analyst (LPA), Luis J. Gomez met with licensee, Nadia Lama. Purpose of the inspection was explained and is for an annual inspection and review COVID-19 best practices. Present in facility was the licensees caring for one child; Infant age. Licensee is within the required capacity on this day. Licensee’s home is a three bedroom, two bathroom, three level house. Days and Hours of operations are: Monday – Friday, 8:00 A.M., to 5:00 P.M. Day-care Areas: Top Level Bedroom #1, Bathroom #1, Living Room Area ( Playroom) Ground level: Backyard Area Off-limit Area: Top Level: Kitchen, Bedroom #2, Living Room #2 Middle Level: Bedroom #3, Bathroom #2 Ground level: Garage.Home was inspected with the licensee for health and safety hazards.

At 12:50P.M., LPA inspected Playroom, Bedroom #1 and Bathroom #1. Day-care area was clean, orderly and had a variety of age appropriate books, games and toys for the children. All furniture and playthings inspected were in good repair. There were storage baskets for children’s belongings and child size tables and chairs for snack and activities. Bedroom #1, located in the top level, has several cribs available for nap time. Outlets and trash cans have been covered. Bathroom #1 was clean with adequate supplies for the children. Licensee installed extra hand washing station in facility hallway. Facility is the proper temperature, with ventilation and natural lighting. Off-limit areas were made inaccessible with use of locked doors and child safe gates.

At 1:15P.M. LPA inspected backyard area. LPA observed area is completely enclosed with tall fencing. Outdoor playthings were in good repair. LPA inspected shed in backyard area. Home does not have a swimming pool, spa, hot tub, fishpond or any other bodies of water. Day-care had a functioning cell phone, smoke/ carbon monoxide detector combo and a fully charged fire extinguisher (2A:40BC), located in the hallway. (REFER TO 809-C FOR CONT.)
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 06/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/04/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: LAMA, NADIA V.
FACILITY NUMBER: 384004090
VISIT DATE: 06/04/2021
NARRATIVE
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At 2:00P.M., LPA reviewed children’s files and facility files.
At 2:10P.M., During facility file review, LPA observed licensee is not conducting or documenting emergency disaster drills every six months. Licensees CPR/ 1st aid certifications were current, expiring: 02/2023. LPA reminded licensee to renew mandated reporter training certificate once every two years. Per licensee, program provides lunch and snack for the children. There were no guns or weapons in the home. Licensee has three dogs. Per licensee all dogs have been vaccinated.

Incidental Medical Services (IMS) 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 Americans with Disabilities Act (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: www.ada.gov/childqanda.htm.

During inspection,
· Applicant was informed about the Provider Information Notices (PINs) on CCLD website. Safe Sleep handout and PINs were discussed with licensee.
· Licensee was reminded about Mandated Reporter training available on CCLD website. Training must be completed every 2 years. Training can be taken online at www.mandatedreporterca.com
· Licensee was reminded about the Provider Information Notices (PINs) on CCLD website.
Licensee was advised for any additional questions to contact CCLD office, Monday to Friday, 8:00 am - 5:00 pm, (650) 266-8800 or 1 (844) 538-8766. Website: www.cdss.ca.gov

Based on today's inspection, a deficiency was observed and cited in the areas evaluated according the Title 22 Division 12 Ca. Code of Regulations. Exit interview and plan of correction was discussed with, Nadia Lama, and her signature of this form acknowledges receipt of these documents.



>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 inspection was posted.
Licensee was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2021
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Document Has Been Signed on 06/04/2021 03:17 PM - It Cannot Be Edited


Created By: Luis Gomez On 06/04/2021 at 02:42 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: LAMA, NADIA V.
FACILITY NUMBER: 384004090

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/04/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/08/2021
Section Cited
CCR
102417(g)(9)(A)(1)

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102417(g)(9)(A)(1) Operation of a Family Child Care Home. All homes shall conduct fire and disaster drills at least once every six months and document the date and time of each drill. This requirement is not met as evidenced by:
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Licensee will conduct and document an emergency disaster drill by the due date: 6/8/2021
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Based on interviews and facility file review, LPA confirmed licensee is not conducting or documenting emergency disaster drills once every six months. This is a potential health and safety risk to children in care.
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Licensee will submit proof of correction to LPA Gomez via email.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Cindy Interiano
LICENSING EVALUATOR NAME:Luis Gomez
LICENSING EVALUATOR SIGNATURE:
DATE: 06/04/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/04/2021


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