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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 213002658
Report Date: 03/29/2023
Date Signed: 03/29/2023 12:21:02 PM


Document Has Been Signed on 03/29/2023 12:21 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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:C.A.M. (CFS) HAMILTON (INF)FACILITY NUMBER:
213002658
ADMINISTRATOR:LOMBARDI KELSEYFACILITY TYPE:
830
ADDRESS:5520 NAVE DRIVETELEPHONE:
(415) 883-5318
CITY:NOVATOSTATE: CAZIP CODE:
94949
CAPACITY:36CENSUS: 19DATE:
03/29/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:14 AM
MET WITH:Buntawan VamnutjindaTIME COMPLETED:
12:35 PM
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On 3/29/2023, Licensing Program Analyst (LPA), Hanson Leong, made an unannounced annual visit to C.A.M Hamilton Infant facility. The LPA was granted entry by the Site Manager, Buntawan Vamnutjinda. The LPA explained the purpose of the visit to Ms. Vamnutjinda. All the individuals listed on the facility’s roster have been granted permission to work or be present in a childcare facility. The LPA observed eight staff members supervising nineteen infants. Children's capacity and ratio requirements were observed to be in compliance.

LPA and the site manager both performed comprehensive inspections of the facility to look for possible threats to health and safety. The facility offers a first aid kit that is completely loaded with everything that is required for the treatment of wounds and other types of injuries. Toys, furnishings, and learning materials in all classes are age appropriate. The LPA observed that the playground equipment and outdoor furnishings are in very good shape. The LPA noted that there were no bodies of water present at the facility. All poisons, cleaning products, and other potentially harmful substances have been stored in a location that is inaccessible to children. The building is equipped with smoke detectors, carbon monoxide detectors, fire extinguishers that are properly charged, centralized smoke alarms, and phones that are in working order.

The site manager has stated that the facility does not house any firearms or other types of weapons.

The LPA observed that the facility posted the required documents. (i.e., license, waivers, notification of parental rights, notification of personal rights, car seat law, emergency disaster plan, and daily activities).

Five different children's files were reviewed by the LPA. All required forms were in the files of the five children.

Five different staff members' files were reviewed by the LPA. All required forms were in the files of the five staff members. Review of the training records shows that all five staff members are current with their Pediatric First Aid / CPR certifications.


***See Page 2 for continuation***
SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson LeongTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 03/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/29/2023
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 2


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: C.A.M. (CFS) HAMILTON (INF)
FACILITY NUMBER: 213002658
VISIT DATE: 03/29/2023
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Continued, Page 2
According to the site manager, the facility satisfies the requirements by carrying out simulations of fire and earthquake drills every other month, as well as by documenting their results.

The following reminders were discussed with the site manager:


1. All adults 18 and over living or working in a licensed childcare facility, 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 childcare facility.
2. Incidental Medical Services (IMS) policy
3. As of January 1, 2018, all staff must complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.
4. Regulations for safe sleeping in accordance with the Health and Safety Code. 5. Checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/

No deficiencies were issued today

A copy of this report, and the “Notice of Site Visit” were given to Buntawan Vamnutjinda

A “Notice of Site Visit” must remain posted for 30 days.

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

An exit interview was conducted, and the report was reviewed with the Site Manager, Buntawan Vamnutjinda
SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson LeongTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023
LIC809 (FAS) - (06/04)
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