Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005347
Report Date: 01/12/2018
Date Signed 01/12/2018 11:13:06 AM

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:MOORE, ELIANA C.FACILITY NUMBER:
214005347
ADMINISTRATOR:MOORE, ELIANA C.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 891-8676
CITY:CORTE MADERASTATE: CAZIP CODE:
94925
CAPACITY:14CENSUS: 11DATE:
01/12/2018
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Eliana MooreTIME COMPLETED:
11:00 AM
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LPA Ng made a required 3 year inspection to the facility at issue, present was the Licensee and an aide with 11 children, one being less than 2 years of age. The Premises is on the ground level and consist of 3 rooms with one attached to the main house. The main house is off limits and the kitchen is in this area of the house. The main house except for the family room is off limits including the bedroom, currently the provider has turned the bedroom into storage for the facility and has made it inaccessible. All adults were fingerprinted and cleared. There are barriers which will prevent access by children to the off limits area, including the main house and the master bedroom these doors have child resistant door knob devices. In the Bathroom toxins and Hazardous materials were inaccessible to children. The facility does have a fully charged extinguisher that meets the minimum requirements, and a smoke detector was tested and working, a carbon monoxide detector was not available. applicant states she uses her cell phone and a hard line telephone. Applicant was advised to keep temperature between 68 to 85. There are ample toys available for children. Applicant states that she has no firearms, weapons, or pets. Bodies of water such as fish tanks, baby walkers, bouncers, excersaucers, Jumpers were not observed. Licensee was advised that off limit areas are subjected to inspections. Applicant states her discipline method will be redirection and talking to the child, and that isolation of sick children will be provided by separating a sick child in the applicant’s family room while the other children are in the Secondary unit area and calling parents for pick up. All electrical covers were properly covered, throw rugs were non skid and an advisory was made to the applicant regarding hot water, that all hand-washing activities must be supervised to prevent children from scalding their hands and as best practice to keep Hot water below 120 degrees. Emergency numbers were posted. There are two outside spaces that will be used, there is a play structure and the area is rubberized on one side and grass on the other. Roster was available for review. Applicants CPR and First aid is current and will expire 11/14/18. The applicant conducted a emergency drill and the last logged event was on 10/06/17, Insurance is current. Incidental Medical Services (IMS) policy 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 ADA was provided:
SUPERVISOR'S NAME: Suzanne Roman-ClarkTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Tony NgTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2018
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: MOORE, ELIANA C.
FACILITY NUMBER: 214005347
VISIT DATE: 01/12/2018
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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. Facility was also informed that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662. All aides and licensee have current required Immunization record. forms and other child care information can also obtained on the website. Currently no children were on any medication at this time. This report has been explained and discussed with the Licensee. Notice of Site visit was observed to be posted by the licensee. New regulations discussed with the licensee, ( civil penalties, licensing information availability to the public, smoking prohibition, immunization for children, carbon monoxide detectors and Childhood Nutritional Training requirements.) licensee was also advise to review new and updated regulations on the ccld.ca.gov website for more information.
SUPERVISOR'S NAME: Suzanne Roman-ClarkTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Tony NgTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2018
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: MOORE, ELIANA C.
FACILITY NUMBER: 214005347
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/12/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/26/2018
Section Cited
HSC
1597.543
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§1597.543 Every family day care home for children shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections.( no CO meters available.)
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Licensee states will install a CO meter by the due date.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Suzanne Roman-ClarkTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Tony NgTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2018
LIC809 (FAS) - (06/04)
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