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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005217
Report Date: 10/12/2023
Date Signed: 10/12/2023 02:39:38 PM


Document Has Been Signed on 10/12/2023 02:39 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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:ZOILA-SHAFFER, MICHELLE E.FACILITY NUMBER:
214005217
ADMINISTRATOR:ZOILA-SHAFFER, MICHELLE E.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 453-3919
CITY:ROSSSTATE: CAZIP CODE:
94957
CAPACITY:14CENSUS: 9DATE:
10/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Michelle Zoila ShafferTIME COMPLETED:
02:45 PM
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On 10/12/2023, Licensing Program Analyst (LPA) Hanson Leong, made an unannounced annual visit to the Family Child Care Home listed above. The LPA was granted entry by the Licensee, Michelle Zoila Shaffer. The LPA explained the purpose of the visit to Ms. Zoila Shaffer. The LPA observed Ms. Zoila Shaffer and her assistant supervising one infant and eight preschool aged children. The LPA observed Ms. Zoila Shaffer and her assistant walking the nine children to a church where the children would be picked up. All individuals listed on the facility’s roster have been granted permission to work or be present in a childcare facility. The facility is operating within its capacity and in accordance with the required ratio of staff to children.

Day-care Areas: Kitchen area, Playroom area, Bedroom #3 (upstairs for napping only), hallway bathroom outdoor/indoor and playground area.

Off Limit Areas: Living room, Garage, and Bedrooms #1 & #2 located in the lower level of the home.

The LPA and Ms. Zoila-Shaffer both performed careful inspections of the daycare facility to look for any potential health and safety hazards. Toys and equipment that are suitable for children of the proper age range are provided at the daycare. The building has sufficient lighting and ventilation, and it is free of any defects or conditions that put children at risk. The facility is equipped with a first aid kit that is completely loaded with everything that is required for the treatment of injuries. The daycare facility is equipped with a smoke detector, a carbon monoxide detector, and a fire extinguisher that is always ready for use. Every garbage can and power outlet has been covered. Products for cleaning and washing, detergents, and any other materials that could put children in danger are stored out of the children’s reach. The LPA did not find any walkers, bouncers, or other comparable objects during today’s inspection. According to Ms. Zoila Shaffer, there are no firearms or other weapons on the premises. The LPA found a swimming pool that is gated, locked, and fenced completely in a different area of the property and completely away from the areas of care.

The LPA observed that the facility had posted all the required forms, including the facility license, Notification of Parental Rights, and Earthquake Preparedness Checklist. ***See Page 2***

SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson LeongTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/12/2023
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 3


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: ZOILA-SHAFFER, MICHELLE E.
FACILITY NUMBER: 214005217
VISIT DATE: 10/12/2023
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Continued, Page 2
The LPA reviewed the files of five different children, The LPA observed the files of the five children contain immunization information, as well as the names, addresses, and phone numbers of each child's authorized representative.

The LPA reviewed the files of Ms. Zoila Shaffer and her assistant. The LPA observed that both staff members are current with their Pediatric First Aid/CPR certification. The LPA also observed that both staff members are current with their Mandated Reporter training certification.

The LPA reviewed the facility's emergency drill log. According to the facility emergency drill log, the last fire drill was carried out on 6/27/2023.

Ms. Zoila-Shaffer was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.



Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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: https://www.ada.gov/resources/child-care-centers/.

LPA discussed the safe sleep regulations with Ms. Zoila Shaffer and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed Ms. Zoila Shaffer 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.
***See Page 3 ***
SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson LeongTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: ZOILA-SHAFFER, MICHELLE E.
FACILITY NUMBER: 214005217
VISIT DATE: 10/12/2023
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Ms. Zoila Shaffer was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, Ms. Zoila Shaffer confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

On 10/12/2023, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

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 information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. 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/inspection-process.

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

A copy of today’s report was given to Michelle Zoila Shaffer. The Notice of Site Visit was given Michelle Zoila Shaffer and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Exit interview conducted and report was reviewed with Michelle Zoila Shaffer.

SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson LeongTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3