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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004899
Report Date: 06/01/2022
Date Signed: 06/01/2022 11:43:14 AM

Document Has Been Signed on 06/01/2022 11:43 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:ALVES, ALINE C.FACILITY NUMBER:
414004899
ADMINISTRATOR:ALINE C. ALVESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 389-6974
CITY:SAN MATEOSTATE: CAZIP CODE:
94402
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
06/01/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Aline AlvesTIME COMPLETED:
11:55 AM
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On 6/1/2022 at 8:50A.M., Licensing Program Analyst (LPA), Luis J. Gomez met with Licensee, Aline Alves for an announced, prelicensing inspection. Purpose of inspection was explained and was for change of location. Present during inspection was the licensee, helper and adult occupant. Home is a three bedroom, one bathroom, two level house. Updated rental contract was submitted to the Department. Days and hours of operations are: Monday- Friday, 8:00 A.M., to 5:00 P.M. Day-care Areas are: Lower Level: Playroom, Outdoor Play Area, and Upper Level: Bathroom #1 Off-limit Areas are: Lower Level: Bedroom #1, Gated Laundry Area, Garage and Upper Level: Kitchen, Bedroom #2, Bedroom #3, Livingroom and Upper Outdoor Patio. LPA inspected home, indoors and outdoors, with licensee for health and safety hazards.

At 8:55A.M., LPA observed the following: Home was clean, orderly and had a variety of age-appropriate toys, books and supplies for the children. Playthings and furniture inspected were in good repair. Area rugs had been installed for added safety. Playroom had child sized tables and chairs for snack and activities. LPA observed individual cubbies for storage of children’s belongings. Playroom was equipped with diaper changing table. Per licensee, table will be disinfected after each use. For napping services, licensee had stackable cots stored in the off-limit areas. Fixtures located in bathroom #1, on Upper Level, were in proper operating condition. Accessible electrical outlets and trash bins had been covered. Safety locks had been installed on laundry area cabinets to prevent child access. Home had ventilation throughout. Per licensee, the off-limit areas will remain locked during operating hours. Home had a functioning telephone, smoke/ carbon monoxide combination and fully changed fire extinguisher (3A:40:BC), located in the laundry area. Pull alarm was observed during inspection. Per licensee, isolation of an ill child will be in the playroom. All detergents, cleaning compounds, medications and other items which could pose a danger were stored inaccessible to children. Per licensee, home does not have any no guns or weapons.

At 9:10A.M., LPA inspected Outdoor Play Area. Area had been completely enclosed with tall fencing. Area was free of debris or any hazardous plants. Staircase leading to upstairs area had been properly barricaded with child safety gate. LPA observed accessible shaded resting area. Home did not have pools, fishponds, jacuzzis or other bodies of water. (REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 06/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/01/2022
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 3
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: ALVES, ALINE C.
FACILITY NUMBER: 414004899
VISIT DATE: 06/01/2022
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(PAGE 2)

At 9:30A.M., LPA reviewed required forms with the licensee. LPA reviewed the LIC311D, Records to Keep in Your Family Child Care Home, children’s forms/ records, facility forms, and information to be posted.

Licensee’s Cardiopulmonary Resuscitation/ First Aid certification was current, expiring on: 6/17/2022. LPA reminded licensee to update certification prior to due date. Licensee’s Mandated Reporter Training certificate (AD1207) was current, expiring on: 1/20/2023.

Licensee was informed that the Department must be notified prior to the use of any off-limits areas. LPA and the licensee discussed licensing regulations and the capacity requirements. Any children under 10 years of age will be counted in the capacity. Licensee was advised that all food containers brought from home must be properly stored and labelled. Licensee understands the required emergency disaster drills are to be conducted and documented every six months. Applicant understands that the use baby walkers, bouncers, jumpers and similar items are not to be used for children in care. Smoking is prohibited inside a Family Childcare Home.

Licensee was reminded that as of September 1, 2016, a person may not be employed or volunteer at a childcare facility, unless he or she has been immunized for influenza, pertussis and measles or qualifies for an exemption pursuant to Health and Safety Code 1596.7995 and 1597.662.

Licensee was reminded that all adults 18 years and over living or working in the home, including employee and volunteers, must obtain criminal 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 Child Care Licensing Safe Sleep Web page at:https://www.cdss.ca.gov/inforesource/child-care-licesning/public-information-and-resources/safe-sleep as an additional resource. LPA informed licensee of the importance of checking for recalled infant devices on United States consumer Product Safety Commission (CPSC) website at http://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. (REFER TO 809C, FOR CONT.)
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2022
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: ALVES, ALINE C.
FACILITY NUMBER: 414004899
VISIT DATE: 06/01/2022
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(PAGE 3)
Incidental Medical Services (IMS) 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 Americans with Disabilities Act (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: www.ada.gov/childqanda.htm.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important communication platform.

To receive important licensed- related information to licensed facilities, visit the CCLD important information website at https://www.cdss.ca.gov/infosource/community-care-licensing/subscribe and select the child care option to receive email communication.

During today's inspection licensee submitted the following items: Prelicensing Readiness Guide (LIC9217) and Proof of Required Immunization.

Fire Clearance Approval for large capacity was received by the Department on: 5/23/2022.

Prior to recommendation for Change of Location, licensee must complete the following:

-Submit Proof of required Immunization for all adult occupants

-Submit LIC508, for all adults in the home

Exit interview was conducted with licensee, Aline Alves and copy of this report was provided. This report will be kept in the facility file and made available for public review upon request. Desk Duty is available Monday through Friday between 8AM - 5PM at (650) 266 -8800.

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2022
LIC809 (FAS) - (06/04)
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