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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004819
Report Date: 08/02/2021
Date Signed: 08/02/2021 10:51:45 AM

Document Has Been Signed on 08/02/2021 10:51 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:TIMOTE, LORENAFACILITY NUMBER:
414004819
ADMINISTRATOR:TIMOTE, LORENAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 440-1029
CITY:SAN MATEOSTATE: CAZIP CODE:
94401
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/02/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Lorena TimoteTIME COMPLETED:
11:05 AM
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Licensing Program Analyst (LPA) Marie Rodriguez met with Licensee Lorena Timote for a scheduled Pre-Licensing inspection. Licensee has relocated from Facility #414004616 to this location. Home is a single story two bedroom and one bathroom home with a separate bedroom unit in the backyard. Licensee owns home and lives there with husband and two minor children.

LPA and Licensee inspected entire home for Health and Safety Hazards. Daycare Areas: Living room (toddler room), dining room, bedroom #2 (infant room), bathroom, backyard, and bedroom unit in the backyard. Off Limit Areas: Kitchen, bedroom #1, garage, and front yard. All off limit areas, including all closets are properly barricaded. Home is clean and orderly with sufficient lighting and ventilation. Home has age appropriate toys and equipment available for children in care. Play structure in the backyard has sufficient padding underneath. Home has a working smoke and carbon monoxide detector, a working telephone, and a fully charged fire extinguisher. First Aid Kit is fully stocked and accessible. There are no pools, spas, or bodies of water on the property. All cleaning supplies, poisons, and other chemicals are stored inaccessible to children. All harmful and sharp objects are made inaccessible from children in care. Licensee states there are no guns or weapons in the home.

Licensee states she will conduct an emergency drill once every six months and will log drills. Licensee states discipline policy is redirection. Licensee's First Aid/CPR certificate expires in July 2023. Postings will be posted by the front door. The Licensee is reminded of NO walker, exersaucers, jumpers, bouncers and any similar items to be used for children in care and shall be made inaccessible. Licensee is advised all adults, 18 years and older living in the home, helper, or assistant must have criminal record clearance and must be associated to the facility by submitting an LIC 9182 with a copy of CA Driver's License or CA ID prior to having any contact with children in care. Failure to do so may result in an immediate civil penalty of $100 per day.

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SUPERVISORS NAME: Alma Malig
LICENSING EVALUATOR NAME: Marie Rodriguez
LICENSING EVALUATOR SIGNATURE: DATE: 08/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/02/2021
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: TIMOTE, LORENA
FACILITY NUMBER: 414004819
VISIT DATE: 08/02/2021
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During inspection,
  • Licensee was given information regarding PIN 20-24-CCP Safe Sleep Regulation, PIN 20-01-CCP Required Lead Testing for Drinking Water, and Lead Poisoning Facts Flyer.
  • Licensee was informed of recent PIN 21-22-CCP Local Licensing Call for Child Care Providers Regarding COVID-19.
  • Licensee was reminded, as of September 1, 2016, all Staff and Volunteers must provide proof of immunization against pertussis, measles, and influenza, or qualifies for an exemption, pursuant to Health and Safety code 1596.7995 and 1597.622.
  • Licensee was reminded about Mandated Reporter training available on CCLD website. Training must be completed every 2 years by all staff hired. Training can be taken online at www.mandatedreporterca.com. If training is not available in native language, a statement can be written stating exemption until the translation is available.
  • Licensee was reminded about the Provider Information Notices (PINs) on CCLD website.
  • Licensee was reminded for any additional questions to contact CCLD office, Monday to Friday, 8:00am - 5:00pm, (650) 266-8800 or 1 (844) 538-8766. Website: www.cdss.ca.gov.

Mandatory Posting Requirements: License, Emergency Disaster Plan, and Notification of Parents Rights Poster.

Capacity limits of a Small and Large License were discussed with Licensee. Licensee was reminded that when operating at a Large capacity, there must be a Helper present.

Fire clearance inspection requested by CCLD was conducted and granted on July 28, 2021.

Large Family Child Care License has been granted and is effective as of today, August 2, 2021.

This report was discussed and explained to Licensee Lorena Timote. A copy of the report was provided.
SUPERVISORS NAME: Alma Malig
LICENSING EVALUATOR NAME: Marie Rodriguez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2021
LIC809 (FAS) - (06/04)
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