414004584-6-29-2021-05-CC-GASL-C4G2TN-20210629174102

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004584
Report Date: 06/29/2021
Date Signed: 06/29/2021 05:41:40 PM

Document Has Been Signed on 06/29/2021 05:41 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:	CARDENAS, EDELMIRA		FACILITY NUMBER:	414004584
ADMINISTRATOR:	CARDENAS, EDELMIRA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 305-9477
CITY:	ATHERTON	STATE: CA	ZIP CODE:	94027
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 3	DATE:	06/29/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Edelmira Cardenas		TIME COMPLETED:	02:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Glenn Schnell conducted an annual random inspection which included inspecting the home and yard, and reviewing the required day-care forms with the licensee today. Present in the home is Licensee and three day care children. Capacity and ratio requirements of children was observed in compliance today. This type of home is a single family home. Edelmira has a day care area of the home that is used for the children including a fenced in yard. Adults living in the home are Alexander and Abraham. 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 must also notify the parents if care is being provided to the two additional children. The day-care operates 7:30 am -5 pm, Monday through Friday. Licensee has parent’s sign the affidavit for liability insurance. 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 fireplace in the day-care area that is screened. 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 (Licensee must be directly present with children any time they are outside). Licensee states there are no pets in the home. Licensee’s CPR and First Aid expires 4/2023.

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Glenn A Schnell
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2021

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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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: CARDENAS, EDELMIRA	FACILITY NUMBER: 414004584
	VISIT DATE: 06/29/2021

NARRATIVE

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Emergency drills are conducted at least once every six months and properly logged. Licensee provides/does not provide daily snacks and meals. Discipline used is talking and redirection. Isolation of sick children reviewed/discussed. Children’s roster was reviewed and is complete and up-to-date. Children and staff/helper files were reviewed and are complete. Supervision and transportation of children was discussed. Capacity options were reviewed. 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 has updated immunization's and Mandated Reporter Training needs to be updated. 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 Licensee does not provide IMS.

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).

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Glenn A Schnell
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2021

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: CARDENAS, EDELMIRA	FACILITY NUMBER: 414004584
	VISIT DATE: 06/29/2021

NARRATIVE

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Lead Flyer Requirement Health and Safety Code 1596.7996, mandated that, effective January 1, 2019, CCCs and FCCHs are required to provide parents and guardians of children enrolling or re-enrolling in care with written information on the risks and effects of lead exposure, blood lead testing requirements and recommendations, and options for locations of affordable blood lead tests as specified. A Lead Poisoning Facts Flyer was created, in partnership with the California Department of Public Health (CDPH), to satisfy this requirement. This flyer must be provided to parents and guardians upon enrolling or re-enrolling any child in care.

Licensee was advised of the Title 22 changes to regulations regarding ‘Safe Sleep” and napping requirements. The following link contains the website location where the changes can be reviewed: https://cdss.ca.gov/inforesources/pre-hearing-regulations/ord-no-0318-03

LPA discussed program’s COVID-19 protocol and required postings. Applicant was informed that access to available Personal Protective Equipment (PPE) may be available through the local child care resource and referral agency.

The requirement for Lead Water Testing was discussed (H&S Code 1597.16).

Report was reviewed and signed by Licensee, Edelmira Cardenas. Today’s report, 6/29/21, will be sent to Edelmira at happyfeetcares@yahoo.com by close of business, 6/29/21. Confirmation of receipt is required.

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

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Glenn A Schnell
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2021

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: CARDENAS, EDELMIRA	FACILITY NUMBER: 414004584
	VISIT DATE: 06/29/2021

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LPA Schnell requested the following documents to be sent to Licensing:
-Signed Criminal Record Statement (LIC 508) for Abraham
-Certificate of Completion for Mandated Reporter Training for Edelmira
-Copy of Immunization's for Edelmira (Tdap, MMR, and Flu*) *Licensee may decline flu shot but a written statement to decline is required to be submitted for Edelmira.

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 emailed and Licensee will post. Notice to remain posted for 30 days.

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Glenn A Schnell
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2021

LIC809 (FAS) - (06/04)

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