384001824-10-31-2023-05-CC-LGOZ-CX5MT5-20231031095258

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384001824
Report Date: 10/19/2023
Date Signed: 10/31/2023 09:53:07 AM

Document Has Been Signed on 10/31/2023 09:53 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	STEIN, SARAH E.		FACILITY NUMBER:	384001824
ADMINISTRATOR:	STEIN, SARAH E.		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 648-1316
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94110
CAPACITY:	14	CENSUS: 10	DATE:	10/19/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:20 AM
MET WITH:	Sarah Stein		TIME COMPLETED:	02:15 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 10/19/2023 at 11:20AM., Licensing Program Analysts (LPA), Luis J. Gomez met with Licensee, Sarah Stein. Purpose of the inspection was explained and was for an Unannounced; Annual Random. Present was the licensee and helper caring for 10 children. (1 infant-age, 9 preschool age). Adults have their criminal record clearances on file. Licensee’s home is a 3 bedroom, 2 bathroom, 2 level house. Days and hours of operation are Monday- Friday, 8:00AM- 5:00PM. Day-care area are: Living Room (Playroom); Kitchen; Family Room (Playroom #2); Bedroom #1 (Imagination Room); Bathroom #1; Dining Area and Outdoor Play Yard. Off-limit area are: Lower Level: Bedroom #2, and Garage. LPA inspected home, inside and outside, with licensee for health and safety hazards. At 11:25AM., the following was observed: Facility was clean, orderly, with age-appropriate playthings available for the children. Floors/ground was clear of obstructions or potential hazards. Accessible furniture, blocks, and books were in good repair. Children’s cubbies are in entry way for added storage. Dining Area has child sized tables and chairs for seated activities. For napping services, LPA observed several cots available in bedroom #1. Per licensee, supplies are washed weekly by families. The off-limit areas have been made inaccessible with safety locks installed. Bathroom #1 was clean, with supplies for hand washing. Fixtures tested were in operating condition. Poisons, detergents, cleaning compounds, medicine, and other items which poses a danger if readily available, have been made inaccessible to children. Facility was the proper temperature, with sufficient ventilation and lighting. Home had functioning telephone service; smoke detector, carbon monoxide detector; and fire extinguisher: 3A:40:BC, fully charged. (REFER TO 809C, FOR CONT)

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023

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

FACILITY NAME: STEIN, SARAH E.	FACILITY NUMBER: 384001824
	VISIT DATE: 10/19/2023

NARRATIVE

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(Page 2)
At 11:55AM., LPA reviewed the outdoor play yard. Yard was completely enclosed. Per licensee, sandbox area is reviewed daily for hazardous items and foreign objects. Facility does not have any pools, fishponds, or other bodies of water.

At 12:05PM, LPA reviewed facility records including the children’s files and personnel files. Children’s files were reviewed and included the: Notification of Parent's Rights (LIC995); Identification of Emergency Information (LIC702); Immunization Records; Physician Report (LIC503); and Notice of Additional Children in Care (LIC9150).

LPA reminded licensee to ensure authorized representatives sign the required ‘Consent for Medical Treatment’ (LIC627).

At 12:45PM., Based on record review, LPA confirmed licensee licensee is not documenting infant napping conditions for each 15-minute review. Advisory Note: Technical Violation (LIC9102TV) was issued.

Licensee's Cardiopulmonary Resuscitation (CPR)/ First Aid certification was current, expiring: 7/2025.
Licensee’s ‘Mandated Reporter Training’ Certification’(AB1207) was current, expiring: 10/2024.

Licensee is conducting and emergency disaster drills every six months, with last drill completed on:6/2023, properly logged. LPA advised licensee to document entire date for each drilled conducted.

Required forms are posted in entry way, including the Childcare License; Notification of Parent’s Rights (PUB379); and Emergency Disaster Plan (LIC610A).

Per licensee, isolation of an ill children is in the playroom.

Per licensee, she provides food service for children in care. LPA advised licensee to ensure all children’s food containers brought by families are be labeled. Per licensee, home does not have any firearms.

Licensee was reminded that all adults 18 years and over living in the home, person who provides care and supervision to children, and staff who have contact with children, including employee and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain criminal 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. (REFER TO 809C, FOR CONT.)

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023

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

FACILITY NAME: STEIN, SARAH E.	FACILITY NUMBER: 384001824
	VISIT DATE: 10/19/2023

NARRATIVE

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LPA discussed the safe sleep regulations with licensee and discussed Child Care Licensing Safe Sleep Web page at:https://www.cdss.ca.gov/inforesource/child-care-licesning/public-information-and-resources/safe-sleep as an additional resource. LPA informed licensee of the importance of checking for recalled infant devices on United States consumer Product Safety Commission (CPSC) website at http://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 www.mychildcareplan.org site is a consumer education website that helps families obtain child care by connecting to child care providers and resources and referral agencies (R&R) throughout California.

Incidental Medical Services (IMS) policy was discussed. For IMS information, see PIN 20-02-CCP. When an IMS is provided, a plan for 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- 0382 (TTY) and link to publications: Commonly asked questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

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 tool, please send them 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/inforesource/community-care-licensing/inspection-process.

Based on today's inspection, no deficiencies were cited in areas evaluated according to California Title 22, Div. 12 Chap. 3 Health and Safety Code of Regulations. Exit interview was conducted with licensee, Sarah Stein. Licensee’s signature of this form acknowledges receipt of these documents.

During exit interview, licensee, Sarah Stein confirmed that there are no registered sex offenders living in the facility, and LPA completed the RSO profile. Notice of site visit was given and must remain posted for 30 days.

LPA unable to print report during inspection. Copy of report will be mailed to licensee.

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023

LIC809 (FAS) - (06/04)

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