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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434412499
Report Date: 12/03/2021
Date Signed: 12/03/2021 01:35:29 PM

Document Has Been Signed on 12/03/2021 01:35 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:ALVAREZ, YISSELAFACILITY NUMBER:
434412499
ADMINISTRATOR:ALVAREZ, YISSELAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 331-0770
CITY:PALO ALTOSTATE: CAZIP CODE:
94301
CAPACITY: 14TOTAL ENROLLED CHILDREN: 5CENSUS: 5DATE:
12/03/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Yissela AlvarezTIME COMPLETED:
01:35 PM
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On 12/03/2021 at 8:50am Licensing Program Analyst (LPA) Sabina Dodoo met with Licensee Yissela Alvarez for an UNANNOUCED ANNUAL REQUIRED INSPECTION. Present for the inspection were licensee and one aide who are all fingerprint cleared and associated. The total children enrolled are 5 and the census was 5 at the time of the inspection. The Family Child Care Home is within ratio. LPA(Sabina) provided licensee a copy of form LIC 125. The Family Child Care Center was toured to conduct a Health and Safety Inspection. The center currently operates Monday through Friday from 7:30am to 4:45pm.

The Family Child Care Home is a single-story home(3 bedrooms, 2 bathrooms) consisting of a living room converted into an activity and play room, a bedroom converted into a napping area with see through cribs, a bathroom were children who are potty trained can use the bathroom, a kitchen area where the children’s food and water are prepared, and a fenced backyard which is the play yard for the children. There is also a detached garage located near the back of the backyard. There are chairs and tables equipped for children. The entrance of the home has a handwashing station and hand sanitizers available before entering the home. LPA (Dodoo) observed the activity room (Living room) to be neat with proper ventilation and materials equipped to care for the children. The licensee has the parents meet at front door and they notify the licensee prior to coming to the center via phone, of whether the children or child is sick. At the entrance the licensee does temperature checks of the children before they enter the Family Child Care Home. LPA (Dodoo) observed the bulletin board (parent’s rights, emergency disaster plan, earthquake drills and facility license). The play yard area is fenced with a playhouse, a slide, and car toys. The play yard is covered with green carpet to help absorb falls. There is a gate that blocks the entrance to the driveway and the play yard. The bedroom has a diaper changing table and see through cribs (no infants are enrolled at the center at this time). There are no bodies of water or firearms on the premises. All chemicals, sharp objects (knives or scissors) are kept out of reach of the children.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Sabina Dodoo
LICENSING EVALUATOR SIGNATURE: DATE: 12/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/03/2021
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 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: ALVAREZ, YISSELA
FACILITY NUMBER: 434412499
VISIT DATE: 12/03/2021
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The OFF-LIMIT AREAS are 2 bedrooms, the dining area, the detached garage, and the kitchen.

The ON-LIMIT AREAS are the living room (converted into an activity room), a bedroom (napping area and diaper changing table), the play yard in the backyard and a bathroom for the children who are potty trained.

All hazardous materials and toxins are kept out of reach from children and are not accessible. The Family Child Care Home has a fully charged fire extinguisher 3A-4-10-BC, working smoke detector, working carbon monoxide, telephone and fully stocked first aid kits. The furniture around the classroom is child proof and the toys are stored in safety bins that can be easily accessed by the children.

The Licensee and aide have completed the Health and Safety training, CPR/First Aid is current. The Aide and Licensee are following the immunization laws and have completed the mandated reporter training. The Licensee conducts and documents fire and disaster drills twice a year and the last conducted drill was in August 2021. All required forms are posted and visible for public view.

At 11am LPA (Sabina Dodoo) reviewed 5 children’s files and 2 staff files and documented them on LIC 857 and LIC 859. An updated roster will be emailed to LPA. The staff interview was completed with the Licensee Yissela Alvarez.

Incidental Medical Services (IMS) policy was discussed. This facility does not provide any IMS to children currently. If 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

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Sabina Dodoo
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2021
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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: ALVAREZ, YISSELA
FACILITY NUMBER: 434412499
VISIT DATE: 12/03/2021
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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.

Licensee was reminded that all adults 18 and over working in Child Care Center, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee 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 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.

Licensee was reminded of the responsibility as a mandated reporter and the trainings must be done once every two years as well as CPR/First Aid needs to be renewed every two years and must be EMSA approved. LPA also encouraged licensee to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, as well as all forms can be downloaded. For licensing updates and Quarterly Child Care Distribution email, email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Sabina Dodoo
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2021
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: ALVAREZ, YISSELA
FACILITY NUMBER: 434412499
VISIT DATE: 12/03/2021
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Effective August 1, 2003 California Law requires Child Care licensees to report unusual incidents or injuries to children in care to child’s parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours to the regional office by phone and the written report, LIC 624 within 7 business days.

There were no deficiencies cited during today’s inspection. A notice of site visit was given and must remain posted for 30 days. Exit Interview and staff interview was conducted with Licensee (Alvarez) at 12:30pm. This report shall remain on file for the next 3 years.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Sabina Dodoo
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2021
LIC809 (FAS) - (06/04)
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