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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004160
Report Date: 09/29/2021
Date Signed: 09/29/2021 12:55:32 PM

Document Has Been Signed on 09/29/2021 12:55 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:ROLDAN, SILVIA E.FACILITY NUMBER:
384004160
ADMINISTRATOR:ROLDAN, SILVIA E.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 879-2418
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94118
CAPACITY: 12TOTAL ENROLLED CHILDREN: 0CENSUS: 10DATE:
09/29/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:06 AM
MET WITH:Silvia RoldanTIME COMPLETED:
01:10 PM
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Licensee Progam Analyst (LPA) Mok conducted an unannounced inspection for the required annual inspection. The purpose of the inspection was explained to her. There were 10 children that included 3 infants with 2 helpers present upon LPA arrival. All adults are fingerprint clearance. The licensee rents this 2 stories single family house. The licensee lives in the house by herself. The house has 2 bedrooms, a living room, dining room, bedroom #1& #2 (Licensee's bedroom that across the bathroom), backyard, and a garage. The daycare areas are living room, dining room, bedroom #1, bathroom, and backyard. The kitchen area is used as a pathway to the backyard only. The off-limit areas are bedroom #2, and a garage. LPA toured the facility for health and safety hazard. There were plenty of age-appropriate toys, books, learning material, and children's furniture available for children. All windows in the living and dining rooms were barricaded to prevent children fall out from the windows. All electrical outlets were covered. There were a fully charged 2A10BC fire extinguisher, working smoke and carbon monoxide detectors and first aid supplies available in the daycare. There was a gate available at the kitchen entrance from the dining room to avoid children's access. The bedroom #1 is next to the dining room for napping. Play pens and mats were available for napping, The licensee provides breakfast, lunch and AM/PM snacks to the children. The children's bathroom was clean and no harmful objects were observed. All the required postings were posted in the daycare areas. LPA also obtained a copy of the current children roster from the licensee during The outdoor play was fenced. The backyard was clean and no harmful objects. There were planty of age-appropriate toys, tide on toys, slide structure, and children's furniture available for the daycare children. The licensee had the hand sanitizer, and touchless thermometer available by the main doorway. The licensee made those items inaccessible to the children. LPA discussed the safe sleep regulations with licensee [or facility representative] 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 [facility representative] 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.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Cindy Mok
LICENSING EVALUATOR SIGNATURE: DATE: 09/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/29/2021
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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