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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004962
Report Date: 11/02/2022
Date Signed: 11/02/2022 11:31:49 AM

Document Has Been Signed on 11/02/2022 11:31 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:AVENDANO, GRETEL B.FACILITY NUMBER:
414004962
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
11/02/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Gretel AvendanoTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Andrea Medlin met with applicant for this prelicensing visit due to a change of location from previous licensed family child care home (Lic 414004825). Days and hours of operation: Monday-Friday 8:30AM-5:30PM. Applicant states that she, husband, and two minor children reside in the home; criminal record clearance is on file for all adults in home. Applicant rents the home; control of property documents verified and are on file. The entire home is inspected for health and safety hazards. This is a two level home. The entire second level is off limits to daycare children. On the second level, there are three bedrooms and two bathrooms. On the first level (lower level) there are: family room (converted to daycare), kitchen (which has been child proofed), laundry room, bathroom, garage, living/dining room. The daycare will operate in the following areas: family room converted into daycare room, bathroom, outside small patio area adjacent to kitchen, and outside areas in backyard. There is a fully charged fire extinguisher that meets minimum requirements, smoke detectors, and a carbon monoxide (CO) detector in the home. First Aid and emergency supplies are available. Applicant will separate a sick child from the group waiting for parent to pick up. Per applicant, there are no firearms or weapons in the home. No pools, spas, hot tubs, fish ponds, or similar bodies of water are present. Applicant has current Pediatric First Aid and CPR and 8 hours of Health and Safety training is on file. There are sufficient age appropriate toys and children's equipment in the day care. Bathroom is clean and hazardous material is child proofed and inaccessible to children. Per applicant, she plans to purchase liability insurance for the daycare. If liability insurance is not purchased, parent's must be given the licensing form "Affidavit of liability insurance"(LIC 282) form. Applicant has verification of the required staff immunizations. Applicant advised to conduct emergency disaster drills at least once every six months and log the date and time of the drill.

(See next page 809-C)
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Andrea Medlin
LICENSING EVALUATOR SIGNATURE: DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/02/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: AVENDANO, GRETEL B.
FACILITY NUMBER: 414004962
VISIT DATE: 11/02/2022
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 If child care is provided to the 7tth and 8th child, children must be school age (6 years or older), Parent Notification, and landlord consent is required. The following is required to be posted in an accessible location in view of parents: Emergency Disaster Plan (LIC 610), Parent's Rights (LIC 995A), and License (once received).

This home meets the requirements of a Family Child Care Home (FCCH) and licensure is recommended and approved as of today, 11/2/2022. Applicant acknowledges and agrees that the previously licensed location (Lic 414004825) is forfeited today.

This report is reviewed with applicant and a copy of this report must be made available for pubic review upon request.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Andrea Medlin
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022
LIC809 (FAS) - (06/04)
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