214200048-11-17-2023-05-CC-HLEG-CXNQ9Q-20231117105843

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 214200048
Report Date: 11/17/2023
Date Signed: 11/17/2023 10:58:49 AM

Document Has Been Signed on 11/17/2023 10:58 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:	PAULSEN, NICOLE		FACILITY NUMBER:	214200048
ADMINISTRATOR:	PAULSEN, NICOLE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 302-3890
CITY:	MILL VALLEY	STATE: CA	ZIP CODE:	94941
CAPACITY:	14	CENSUS: 12	DATE:	11/17/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Nicole Paulsen		TIME COMPLETED:	11:10 AM

NARRATIVE

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On 11/17/2023, Licensing Program Analyst (LPA) Hanson Leong, made an unannounced required visit to the Family Child Care Home listed above. The LPA was granted entry by the Licensee, Nicole Paulsen. The LPA explained the purpose of the visit to Ms. Paulsen. Present in the facility: Ms. Paulsen, an assistant, and 12 preschool aged children. 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. Hours of operation: Mon-Fri, 7:00 am- 6:00 pm.

Daycare Areas: Living Room, Playroom, Preschool Room, Bathroom #1, Garden Area, and Yard Area

Off Limit Areas: Downstairs Bedroom #1, Entire upstairs area (Bedroom #2, Bedroom #3, Bedroom #4, Bathroom #1, Bathroom #2). All off limit areas are properly barricaded.

According to Ms. Paulsen, the physical layout of the home has not changed, with the same daycare and off-limits area.

The LPA and Ms. Paulsen 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. 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. Paulsen, there are no firearms or other weapons on the premises. The LPA found that the facility did not have any pools, spas, or other types of bodies of water of any kind.

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SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson Leong	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2023

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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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: PAULSEN, NICOLE	FACILITY NUMBER: 214200048
	VISIT DATE: 11/17/2023

NARRATIVE

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The LPA observed a designated area for children to sleep or rest quietly. The area has sufficient sleeping mats for each child and are stored in the appropriate location. The LPA reminded Ms. Paulsen that emergency exits must always remain clear, and that sleeping mats cannot be situated in a manner that blocks emergency exits.

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

The LPA reviewed both the children's and staff records. The LPA reviewed the 5 children's records and found that all 5 children have a record of their emergency information on file. Following a review of the staff records, the LPA found that the 2 staff members possess a current certification in Pediatric First Aid/CPR and Mandated Reporter training. Ms. Paulsen’s Pediatric First Aid/CPR certification expires on 5/7/2024.

The LPA reviewed the facility's emergency drill log. According to Ms. Paulsen, the last fire drill was carried out on 11/6/2023. The LPA reminded Ms. Paulsen to document the emergency drills on a log.

Ms. Paulsen 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.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514- 0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at:
https://www.ada.gov/resources/child-carecenters/

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SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson Leong	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2023

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: PAULSEN, NICOLE	FACILITY NUMBER: 214200048
	VISIT DATE: 11/17/2023

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LPA discussed the safe sleep regulations with Ms. Paulsen 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. Paulsen 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.

Ms. Paulsen 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. Paulsen confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

On 11/17/2023, 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.

The LPA observed that the facility is next to another licensed daycare facility, license # 214005300. The LPA reminded Ms. Paulsen that co-mingling of children is not allowed.

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

A copy of today’s report was given to Nicole Paulsen. The Notice of Site Visit was given to Nicole Paulsen 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 Nicole Paulsen.

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson Leong	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2023

LIC809 (FAS) - (06/04)

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