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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435700327
Report Date: 02/27/2024
Date Signed: 02/27/2024 12:39:49 PM

Document Has Been Signed on 02/27/2024 12:39 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:MABILANGAN, SUSANAFACILITY NUMBER:
435700327
ADMINISTRATOR:MABILANGAN, SUSANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 220-3832
CITY:MILPITASSTATE: CAZIP CODE:
95035
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
02/27/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Susana MabilanganTIME COMPLETED:
01:00 PM
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On Tuesday, February 27, 2024 at 12 PM, Licensing Program Analyst (LPA) Manel Estoesta conducted an Unannounced Required Visit. LPA met with the Licensee Susana Mabilangan and explained the nature of the site visit. Present on this visit were the Licensee's spouse, Licensee's Adult Son, 1 infant child and preschool 3 children. The home operates from Monday to Friday 7am to 6pm.

LPA toured the facility to conduct a Health and Safety Inspection with the Licensee. The home is a one story home. The home is neat and clean with heating and ventilation for safety and comfort.

The ON LIMIT AREAS (accessible to children in care) are the living room, day care playroom, dining room, study room across the hallway bathroom and the hallway bathroom.
The OFF-LIMIT AREAS are master bedroom, master bath, the 2 other bedrooms, kitchen, backyard and the garage which will be inaccessible to children in care by closed and or locked doors and or a fence with visual supervision.

There is a gate located at the hallway rooms and the kitchen to prevent access to the OFF LIMIT AREAS. The designated isolation area for a child who becomes ill while in care is the study room. There are ample age appropriate toys that appear to be safe and in good condition. There are no pools, hot tubs or any other bodies of water present during today's inspection. All hazardous materials and toxins are kept out of the reach of children and it was observed that there are no toxins or hazardous items accessible today.

The home has a fully charged 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector and working telephone. The fireplace is being blocked by a furniture to prevent access by children. Per licensee, there are no firearms in the home. The licensee conducts and documents fire and disaster drills twice a year. Licensee does not own the property and maintain the signed the forms LIC 282 AFFIDAVIT REGARDING LIABILITY INSURANCE in the each children's file.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE: DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/27/2024
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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: MABILANGAN, SUSANA
FACILITY NUMBER: 435700327
VISIT DATE: 02/27/2024
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The licensee's CPR and First Aid certificate was issued on July 2023. LPA discussed to the Licensee's assistant that the Mandated Reporter General Training and Child Care Providers training online at https://mandatedreporterca.com/. Licensee has records of Measles and Pertussis immunization, Influenza vaccination and TB clearance. LPA reminded Licensee that only the Influenza vaccination can be decline with a written declination.

Facility roster of children was reviewed, and a copy was obtained. Children’s files were reviewed, which included but not limited to LIC 9150, records of receipt for Parents' Rights Notice, Identification and Emergency Information, Consent for Emergency Medical Treatment form, Sleep Logs and Immunization. The licensee is in ratio today. Licensee stated that she does not transport children at this time.

Licensee was reminded that all adults 18 and over living or working in the home, 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 Family Child Care Home. 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.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

There are no deficiencies cited on this visit.

Exit interview conducted and report was reviewed with the licensee.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024
LIC809 (FAS) - (06/04)
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