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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004467
Report Date: 06/18/2021
Date Signed: 06/18/2021 12:04:13 PM

Document Has Been Signed on 06/18/2021 12:04 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:LIMA LOPEZ, EMILSA I. AND MARTINEZ, FRANCISCOFACILITY NUMBER:
414004467
ADMINISTRATOR:LIMA LOPEZ,E. & MARTINEZ,FFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 290-1184
CITY:MENLO PARKSTATE: CAZIP CODE:
94025
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 11DATE:
06/18/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Licensee, Emilsa Lima LopezTIME COMPLETED:
12:15 PM
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On June 18th, 2021 at 11am, Licensing Program Analyst (LPA) Kassandra Medrano conducted an annual required inspection which included a toured the home and yard, and a review of the required day-care forms with the licensee today. Present in the home is Licensee, Helper and 9 children. Capacity and ratio requirements of children was observed in compliance today. This type of home is a duplex. Off limit rooms were identified as front yard, kitchen, and Bedroom #2. Adults living in the home are Licensee, Husband, and. A review of records indicates that all adults working or living in the home who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Licensee rents home. Licensee has landlord permission to care for two additional children (6 years plus in age and one of the two children can count if they are enrolled in Kindergarten) and has notified the parents that care is being provided to the two additional children. The day-care operates 8 am-7:30pm, Monday through Friday. Licensee has parent’s sign the affidavit. LPA observed the following: Day-care area is clean, orderly, and equipped with age appropriate toys and equipment for the children. No baby walkers, bouncers, exercausers, etc. allowed to be used during day-care hours. Home has proper lighting and ventilation. Home has a working telephone, a working smoke and carbon monoxide detector, and a fully charged 2A10BC fire extinguisher. Licensee states there are no bodies of water on the property. There is a space heater in the day-care area. There are no detergents, or cleaning products accessible to day-care children. Poisons are locked. Licensee states there are no guns or weapons of any kind in the home. The yard is fenced. Emergency drills are conducted at least once every six months and properly logged. Licensee provides daily snacks and meals. Isolation of sick children reviewed/discussed. Children’s roster was reviewed and is complete and up-to-date. Children files were reviewed and are complete. Supervision and transportation of children was discussed. Capacity options were reviewed.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Kassandra Medrano
LICENSING EVALUATOR SIGNATURE: DATE: 06/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/18/2021
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: LIMA LOPEZ, EMILSA I. AND MARTINEZ, FRANCISCO
FACILITY NUMBER: 414004467
VISIT DATE: 06/18/2021
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Licensee understands that care cannot be provided for more than the capacity as stated on the license. Requirements for reporting suspected child abuse was discussed, as well as reporting requirements for unusual incidences. All required postings are properly posted (License/Parent’s Rights poster/Emergency Disaster Plan and Earthquake Preparedness Checklist)

Licensee was reminded that as of September 1, 2016, a person may not be employed or volunteer at a child care 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.

Licensee was informed about the Provider Information Notices (PINs) on CCLD website. Licensee was reminded about Mandated Reporter Training available on CCLD website
(www.ccld.ca.gov or www.mandatedreporterca.com). Information regarding 'A Child Care Provider's Guide to Safe Sleep' was provided to the Licensee and is available for review on CCLD website.

No deficiencies were issued today under Title 22 Division 12 of the California Code of Regulations.

This report and appeal rights were discussed with Licensee. This report must be available in the facility for public review. Notice of Site Visit was posted. Notice to remain posted for 30 days.

Report was reviewed and signed by Licensee, Emilsa Lima-Lopez. Today’s report 6/18/2021 and notice of site visit will be emailed by close of business, date. Confirmation of receipt is required.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Kassandra Medrano
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2021
LIC809 (FAS) - (06/04)
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