384000908-8-2-2024-05-CC-JTSE-D7RVAA-20240802161538

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384000908
Report Date: 08/02/2024
Date Signed: 08/02/2024 04:15:53 PM

Document Has Been Signed on 08/02/2024 04:15 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	CHINCHILLA, LISA M.		FACILITY NUMBER:	384000908
ADMINISTRATOR:	CHINCHILLA, LISA M.		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 333-5323
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94127
CAPACITY:	14	CENSUS: 10	DATE:	08/02/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Licensee, Lisa Chinchilla		TIME COMPLETED:	04:30 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	On 8/2/2024, at approximately 2:45PM, Licensing Program Analyst (LPA) Jonathan Tse conducted an unannounced annual visit at the facility. LPA met with Licensee, Lisa Chinchilla (L1), and explained the purpose of the visit. Present during the visit was L1, two helpers, and 10 preschool age children. The facility is in compliance with staffing and ratio requirements on this day. The facility’s operating hours are from 8:30AM to 4:00PM, Tuesdays to Fridays. Daycare Areas: Room #1, Room #2, Room #3, Bathroom #1, and Backyard. Off-limits Areas: Garage, Storage Room, and entire Upper Level. LPA and L1 inspected the home for any health or safety hazards. LPA observed the home to be in clean and orderly condition. There is a fully charged 2A10BC fire extinguisher present. L1 demonstrated a carbon monoxide detector to be operational during the visit. Electrical outlets are covered or obstructed by furniture when not in use to be inaccessible to children in care. Poisons, cleaning detergents, and other chemicals are stored inaccessible to children in care. There are no fireplaces in the daycare areas. Stairs are barricaded when children are in care. There are heat and ventilation controls available for the comfort and safety of children in care. LPA observed age-appropriate toys and equipment to be present in the facility. Furniture was observed to be age-appropriate and free of rough or sharp edges. Children have access to books, art supplies, and manipulatives. Per L1, children nap on labeled cots, and the facility provides blankets and bedding. Blankets and bedding are cleaned once a week. Per L1, children bring lunch and snacks from home. Children bring water bottles from home and the facility refills them as needed. There are cubbies available for each child and are labeled with each child’s name. Continued on Page Two

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Jonathan Tse	TELEPHONE: (650) 464-4927
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2024

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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: CHINCHILLA, LISA M.	FACILITY NUMBER: 384000908
	VISIT DATE: 08/02/2024

NARRATIVE

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LPA observed the Backyard to be free of debris and other loose articles. LPA observed age-appropriate toys and equipment to be present. There is cushioning in the form of artificial turf. The Backyard is enclosed by a fence that is at least four feet high. There are no pools or other similar bodies of water present in the facility. Per L1, there are no firearms or weapons stored in the facility.

LPA reviewed two staff files, six children’s files, and facility records. L1’s First Aid/CPR expires 2/2025. L1’s Mandated Reporter Training is current and expires 10/2025. Staff immunization records and TB clearances are available for review. LPA observed children’s files to be complete. LPA observed all required postings to be posted and accessible for review upon entry into the facility. The facility last conducted an emergency drill on 5/7/2024. Emergency drill logs are logged on a calendar and were made accessible for review during the visit.

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.

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.

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.
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SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Jonathan Tse	TELEPHONE: (650) 464-4927
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2024

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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: CHINCHILLA, LISA M.	FACILITY NUMBER: 384000908
	VISIT DATE: 08/02/2024

NARRATIVE

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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/.

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

No deficiencies were cited during today’s visit on 8/2/2024. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Lisa Chinchilla.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Jonathan Tse	TELEPHONE: (650) 464-4927
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2024

LIC809 (FAS) - (06/04)

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