214200082-8-9-2024-05-CC-HLEG-D7YQ7K-20240809115517

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 214200082
Report Date: 08/09/2024
Date Signed: 08/09/2024 11:55:28 AM

Document Has Been Signed on 08/09/2024 11:55 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:	GOCHBERG, CLAIRE & JODI		FACILITY NUMBER:	214200082
ADMINISTRATOR:	GOCHBERG, CLAIRE & JODI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 459-5624
CITY:	SAN RAFAEL	STATE: CA	ZIP CODE:	94901
CAPACITY:	14	CENSUS: 5	DATE:	08/09/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:28 AM
MET WITH:	Jodi Gochberg		TIME COMPLETED:	12:10 PM

NARRATIVE

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On 8/9/2024, Licensing Program Analyst (LPA) Hanson Leong conducted an unannounced annual visit to the Family Childcare Home (FCCH) listed above. LPA met with the Licensee, Jodi Gochberg, and explained the purpose of the visit.

Five children (two infants and three pre-k) and two adults were present during the visit. The two adults received criminal record clearance from the department. The licensees hold a large license and are within capacity limits and ratios.

The Co-License, Claire Gochberg provided a written statement to remove herself from the license during today’s visit.

The two licensees rent the home. The hours of operation are Monday through Friday from 7:30 am to 5:30 pm.

LPA observed that all required documents, such as the facility license, the Notification of Parental Rights, and the Earthquake Preparedness Checklist, were displayed in a prominent, publicly accessible location.

The most recent emergency disaster drill was conducted on 6/18/2024, and the LPA observed that it was properly documented. LPA reviewed the emergency disaster drill log and found that they were conducted at least every six months.

Daycare Areas: Living Room, Playroom, Bedroom #1, Bedroom #2, Bathroom #1, Kitchen, and Yard Area.

Off-limit Areas: Bathroom #2. The licensee understands that off-limits areas may not be used for childcare during business hours.

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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: 08/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2024

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: GOCHBERG, CLAIRE & JODI	FACILITY NUMBER: 214200082
	VISIT DATE: 08/09/2024

NARRATIVE

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LPA conducted inspections of the indoor and outdoor daycare areas to identify health and safety hazards. A fire extinguisher, a first aid kit, and multiple carbon monoxide and smoke detectors are present in the home. LPA found the home's interior to be clean and orderly, with proper heating and ventilation for safety and comfort. Disinfectants, cleaning solutions, poisons, and other hazardous items were stored in areas inaccessible to children with child safety locks. The bathroom was found to be clean and fully operational. The toilet and handwashing facility were well-kept, safe, and clean. The bathroom is equipped with appropriate toileting equipment and appropriate sanitation products.

LPA observed that the daycare areas had age-appropriate toys, furniture, and educational materials. Electrical outlets were properly covered with child safety covers. According to the licensee, no firearms or weapons are on the premises.

The licensee does not currently provide food service for the children. The children's families provide their lunches. LPA observed the children’s lunches inside the refrigerator. LPA reminded the licensee that the children's lunches must have the children 's names on them.

The backyard is enclosed by a fence and equipped with outdoor play equipment that is in good condition. The areas around and under high climbing equipment, swings, slides, and similar equipment were observed to be cushioned with wood chips that absorb falls. LPA did not observe any pools, spas, or bodies of water on site. LPA reminded the licensee to ensure children are always supervised if the gate is open in the yard.

The facility's children sleep on mats and in playpens. The playpens were free of loose articles and materials. According to the licensee, the sheets and blankets that are available for the children are washed once or twice a week.

LPA reviewed five children’s files and confirmed three have complete files that include their emergency contact and medical information. Two children were missing form LIC 995a, and one child was missing their immunization records. LPA reminded the licensee to review the Entrance Checklist, LIC 126, to ensure that all required licensing forms are in the child’s file. According to the licensee, she visually checks the children under the age of two when they’re sleeping, but she does not document their sleep every fifteen minutes. LPA reminded the licensee that children under the age of two must use sleep logs that document their sleep every 15 minutes. LPA provided a sample sleeping log to the licensee.

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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: 08/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2024

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: GOCHBERG, CLAIRE & JODI	FACILITY NUMBER: 214200082
	VISIT DATE: 08/09/2024

NARRATIVE

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LPA reviewed the licensee’s files and confirmed that all required forms were present. LPA found that the licensee possesses a current Pediatric First Aid/CPR certification, which will expire on 1/2025. LPA requested the licensee submit her MMR and TDAP vaccination records to the department as soon as possible. The licensee informed the LPA that her Mandated Reporter Training has not been renewed.

Licensee 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 licensee 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 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.

Licensee 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, the licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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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: 08/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2024

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: GOCHBERG, CLAIRE & JODI	FACILITY NUMBER: 214200082
	VISIT DATE: 08/09/2024

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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 facility was issued a technical violation for not completing the fifteen-minute sleep logs for children under the age of two.

Please refer to LIC 809D for today’s citation.

The licensee, Jodi Gochberg, was given a copy of today's report and the facility’s appeal rights.

A Notice of Site Visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Licensee, Jodi Gochberg.

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson Leong	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 08/09/2024 11:55 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: GOCHBERG, CLAIRE & JODI	FACILITY NUMBER: 214200082
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/09/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview, the licensee did not comply with the section cited above, which poses/posed a potential health, safety or personal rights risk to children in care.
	POC Due Date: 09/09/2024
	Plan of Correction
1 2 3 4	The licensee stated she would submit her Mandated Reporter Training certificate to the department by the due date mentioned above.

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: 08/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2024

LIC809 (FAS) - (06/04)

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