214200002-6-28-2023-05-CC-HLEG-CT8Q5E-20230628115150

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 214200002
Report Date: 06/28/2023
Date Signed: 06/28/2023 11:51:58 AM

Document Has Been Signed on 06/28/2023 11:51 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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	GUEDEZ, AURA MARINA		FACILITY NUMBER:	214200002
ADMINISTRATOR:	GUEDEZ, AURA MARINA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 479-1913
CITY:	SAN RAFAEL	STATE: CA	ZIP CODE:	94903
CAPACITY:	14	CENSUS: 12	DATE:	06/28/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Aura Marina Guedez		TIME COMPLETED:	12:00 PM

NARRATIVE

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On 6/28/2023, 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, Aura Marina Guedez. The LPA explained the purpose of the visit to the Licensee. 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 the Licensee and her two assistants supervising four infants, seven preschool aged children and one school aged child. Children's capacity and ratio requirements were not observed to be in compliance. During today's visit, there was a dog present in the home.

Day-care Areas: Playroom, Bathroom #1, and Backyard.

Off Limit Areas: Kitchen, Living Room, Bedroom# 1, Bedroom #2, Bedroom #3, and Bathroom #2.

The LPA and the Licensee both performed careful inspections of the day-care 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 day-care. The building has sufficient lighting and ventilation, and it is free of any defects or conditions that could put the children in its care in 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 day-care 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 their reach. The LPA did not find any walkers, bouncers, or other comparable objects during its inspection.

There are reportedly no firearms or other weapons on the premises, as stated by the Licensee.

The LPA found that the facility did not have any pools, spas, or other types of bodies of water of any kind.

The LPA observed that the facility had posted all the required forms, including the facility license, Notification

of Parental Rights, Earthquake Preparedness Checklist, and Notification of Personal Rights. The Licensee is aware that smoking is not permitted in a family childcare facility.
***See Page 2 for continuation***

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson Leong	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023

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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Document Has Been Signed on 06/28/2023 11:51 AM - It Cannot Be Edited

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: GUEDEZ, AURA MARINA	FACILITY NUMBER: 214200002
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/28/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.622(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview, and record review, the licensee did not comply with the section cited above, which poses a potential health, safety or personal rights risk to children in care.
	POC Due Date: 07/07/2023
	Plan of Correction
1 2 3 4	Licensee will be required to provide a copy of her assistants' immuniation record by the above due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson Leong	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023

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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: GUEDEZ, AURA MARINA	FACILITY NUMBER: 214200002
	VISIT DATE: 06/28/2023

NARRATIVE

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Continued, Page 2
The LPA reviewed the files of five different children. All required forms were in the files of the five children.

The LPA reviewed the files of the Licensee and her two assistants. All required forms were in the files of the Licensee and her two assistants. Review of the training records shows that the Licensee and her two assistants are current with their Pediatric First Aid / CPR certifications. Review of the immunization records show that one of her assistants’ immunization records is missing from their file.

The LPA reviewed the facility's emergency drill log. According to the facility’s emergency drill log, the facility's emergency drills are carried out twice a year,

The Licensee was reminded that 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 the initial presence in a licensed childcare facility. 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.

The Incidental Medical Services (IMS) policy was discussed with the Licensee. 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.

The LPA discussed the Safe Sleep regulations and Child Care Licensing Safe Sleep with the Licensee. Webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource.The LPA also informed the 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.

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 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/process. *** See Page 3 for continuation***

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson Leong	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023

LIC809 (FAS) - (06/04)

Page: 4 of 4

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: GUEDEZ, AURA MARINA	FACILITY NUMBER: 214200002
	VISIT DATE: 06/28/2023

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Continued, Page 3
The following Type B violation (potential health, safety, or personal rights risk to children in care.) was cited for today’s visit:

1. HSC 1597.622(a)(1)- Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

**The department may clear all violations after the review of the facilities’ Plan of Correction***

A copy of today’s report, the “Notice of Site Visit”, and the Licensee’s appeal rights were given to Aura Marina Guedez. 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 Aura Marina Guedez.

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson Leong	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023

LIC809 (FAS) - (06/04)

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