380503488-12-12-2023-05-CC-CMOK-CYFSHE-20231212125326

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 380503488
Report Date: 12/12/2023
Date Signed: 12/12/2023 12:57:50 PM

Document Has Been Signed on 12/12/2023 12:57 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:	SMITH, SHIREL		FACILITY NUMBER:	380503488
ADMINISTRATOR:	SMITH, SHIREL		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 846-8488
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94134
CAPACITY:	14	CENSUS: 2	DATE:	12/12/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Shirel Smith		TIME COMPLETED:	01:25 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Mok conducted an unannounced annual inspection. LPA met with the licensee,Shirel Smith, and explained the purpose of the inspection to her. Per licensee, she plans to retire in 2024. LPA informed the licensee the way to get it done when she ready to retire during the inspection. There were 2 children including an infant and a preschooler present. The licensee owns and lives in this 2 stories single house with her granddaughter. LPA toured and inspected the house for health and safety hazards. The house has 3 bedrooms, 2 baths, kitchen, and dining room on the upper level; lower level had 2 bedrooms, 1 bath, and a big play area that was converted by a garage. The house was clean and in order. All toxins and harmful objects were made inaccessible to children. The day care areas are play area, bathroom on the lower level, and a kitchen on the upper level. The off-limit areas were: all bedrooms and bathrooms on the upper level, 2 bedrooms, and backyard on the lower level. There were a fully charged 2A10BC fire extinguisher, working cellular phone, and first aid supplies available in day care. LPA did not test the 2in1 smoke and carbon monoxide detector due to children were napping during the inspection. There were some children toys and children's furniture available for children. Per licensee, there was no guns, weapons, or pets at home. Children's bathroom was clean and lower cabinet was free of harmful objects. Some Cubbies were available in the daycare area Per licensee, she provides breakfast, lunch and snacks to the day care children. Barricade was used at the stairway. All electrical outlets were covered. Cots and play pens were available for napping. Per licensee, there were no children on special medication. LPA reviewed the children's file during the inspection. The licensee had current CPR/First AId training and Child Abuse Mandated Reporter Training. continues LIC809C

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy Mok	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023

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: SMITH, SHIREL	FACILITY NUMBER: 380503488
	VISIT DATE: 12/12/2023

NARRATIVE

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Criminal Record Clearance - Licensee was reminded that all adults 18 and over living or working in 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.

Safe Sleep - 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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/.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy Mok	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023

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: SMITH, SHIREL	FACILITY NUMBER: 380503488
	VISIT DATE: 12/12/2023

NARRATIVE

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MyChildCarePlan.org – 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.

Megan’s Law - 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.

Notice of Site Visit - A notice of site visit was given and must remain posted for 30 days.

Exit Interview - Exit interview conducted and report was reviewed with the licensee, Shirel Smith.

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

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy Mok	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023

LIC809 (FAS) - (06/04)

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