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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004416
Report Date: 06/07/2022
Date Signed: 06/07/2022 03:00:09 PM

Document Has Been Signed on 06/07/2022 03:00 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:WAGENHALS,KATHLEENFACILITY NUMBER:
384004416
ADMINISTRATOR:WAGENHALS, KATHLEENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 552-3932
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94131
CAPACITY: 14TOTAL ENROLLED CHILDREN: 15CENSUS: 5DATE:
06/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Maia Nelson, Erika Williams, Roshana PariyarTIME COMPLETED:
03:05 PM
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On June 7, 2022 at approximately 12:50pm, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, annual, required inspection. LPA met with facility representatives, H1, H2, and H3 and explained the purpose of the inspection. Licensee previously notified LPA of temporary absence from facility 5/31/2022. Upon LPA's arrival to home, H1 notified licensee of LPA's arrival. Licensee allowed LPA to continue annual inspection with H1, H2, and H3.

Present during inspection included H1, H2, H3 and 5 enrolled children (3 infants and 2 preschool age). Facility is operating within capacity ratio and requirements during inspection. All adults living and/or working in the home have a criminal record clearance on file. Hours of operation are Monday to Friday from 7:15am to 5:30pm.

Licensee rents the home which a multi-level, family home. The home consists of two levels. The DAY CARE AREAS are on the first level of the home that includes the living room (Preschool room #1), dining room (Preschool room #2), bathroom #1, and back porch. The OFF LIMITS AREAS are the kitchen, lower backyard, and entire second level of home. Off limit areas are made inaccessible with child safety gates.

At approximately 1:15pm, LPA toured day care areas of home with either H1, H2 or H3. LPA observed home to be in good repair with proper temperature and ventilation. There were a variety of age appropriate toys and equipment in the home which were in good condition. Home is equipped with a smoke detector, carbon monoxide detector and charged fire extinguisher.

LPA did not observe any pools, spas or bodies of water on the property. The back porch includes stairs going to the lower backyard, an off limit area. Stairs going to the lower backyard are made inaccessible with a child safety gate. Back porch is equipped with appropriate outdoor toys and equipment that are in good working condition. All cleaning supplies, poisons and other chemicals were stored inaccessible to children on home's high cabinets or off limit areas.

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SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE: DATE: 06/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/07/2022
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: WAGENHALS,KATHLEEN
FACILITY NUMBER: 384004416
VISIT DATE: 06/07/2022
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LPA reviewed ten children’s records, 5 of whom were present during inspection. Children's files LPA reviewed were complete and have a record of emergency identification information on file. LPA reviewed Licensee, H1, H2 and H3's files which were also complete. All adults working in the home have a record of required immunizations that were made available for review. Licensee's Pediatric First/Aid CPR is current and will expire 06/2023. At least one helper (H3) on site during licensee's temporary absence, has a valid and current CPR certificate that will expire 12/2023. Last emergency drill conducted was 12/13/2021. Next emergency disaster drill was noted down and scheduled for 06/13/2022.

During inspection, LPA discussed the following with licensee over the phone and discussed with H1 in person:
-Licensee's annual fee and lead poisoning facts flyer.
-As of September 1, 2016, all Staff and Volunteers must provide proof of immunization against pertussis, measles, and influenza, or qualifies for an exemption, pursuant to Health and Safety code 1596.7995 and 1597.622.
-Mandated Reporter training available on CCLD website. Training must be completed every 2 years by all staff hired. Training can be taken online at www.mandatedreporterca.com.
-Provider Information Notices (PINs) on CCLD website.
-For any additional questions to contact CCLD office, Monday to Friday, 8:00am - 5:00pm, (650) 266-8800 or 1 (844) 538-8766. Website: www.cdss.ca.gov.

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: 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.

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 [email protected]. 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

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SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2022
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: WAGENHALS,KATHLEEN
FACILITY NUMBER: 384004416
VISIT DATE: 06/07/2022
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Licensee and facility representative were 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 facility representative 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.

No deficiencies were cited today under CCR, Title 22, Div. 12, Chapt. 1.

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

An exit interview conducted and report was reviewed with facility representative, H1.
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2022
LIC809 (FAS) - (06/04)
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