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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002537
Report Date: 12/10/2024
Date Signed: 12/10/2024 01:46:16 PM

Document Has Been Signed on 12/10/2024 01:46 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:PINHEIRO, ALEXANDREFACILITY NUMBER:
384002537
ADMINISTRATOR/
DIRECTOR:		PINHEIRO, ALEXANDREFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 771-1004
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94112
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
12/10/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Alexandre Pinhero TIME VISIT/
INSPECTION COMPLETED:
11:30 AM
NARRATIVE
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On 12/10/2024 at 8:40AM., Licensing Program Analyst (LPA), Luis Gomez met with Assistant, Wilda Alvarado. The purpose of today’s visit was explained and was for an unannounced, annual random inspection. Licensee, Alexandre Pinhero arrived to facility during inspection. Present was the licensee and two assistant caring for 8 children. (3 infant-age, 5 preschool age). Days and hours of operations are: Monday- Friday, 6:00AM- 9:00PM. The areas of the home designated for childcare are: Living Room (Playroom); Dining Room; Bathroom #1; and the Outdoor Play Yard. Areas of the home designated as off-limits: Bedroom #1, #2, #3, Kitchen (Pass through only) and Entire Lower Level. LPA inspected facility indoors and outdoors for health and safety hazards.

At 8:45AM., the following was observed: Facility was clean, neat, with age-appropriate playthings available for the children.

At 8:50AM., Based on observation, LPA confirmed mattress/ padding inside play pen does not properly fit.

The floors and ground surfaces were clear of any obstructions or hazards. Labeled cubbies are available for storage of children’s belongings. For food services, LPA observed table, chairs, scaled to the appropriate size. Furniture, materials, and supplies inspected were in good repair.

For napping services, several play pens stored in facility.

LPA reminded licensee to remove items from sides of crib. Advisory Note: Technical Violation (LIC9102TV) was issued.

Per licensee, napping supplies are washed twice every weekly. Bathroom #1 was observed clean, with faucet and toilet in operating condition. Home was a comfortable temperature, with ventilation and lighting. Home has telephone service; functioning smoke/ carbon monoxide detector; and fire extinguisher (2A:10BC). (REFER TO 809C, FOR CONT.)

Marie RodriguezTELEPHONE: (650) 266-8800
Luis GomezTELEPHONE: (650) 266-8800
DATE: 12/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/10/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 12/10/2024 01:46 PM - It Cannot Be Edited


Created By: Luis Gomez On 12/10/2024 at 11:21 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: PINHEIRO, ALEXANDRE
FACILITY NUMBER: 384002537

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/10/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(a)(3)
Infant Safe Sleep
(a) There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. (3) Mattresses shall be firm and covered with a fitted sheet that is appropriate to the mattress size, fits tightly on the mattress, and overlaps the underside of the mattress so it cannot be dislodged.

This requirement is not met as evidenced by:
Deficient Practice Statement
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At 8:50AM., Based on observation, LPA confirmed mattress/ padding inside play pen does not properly fit. This poses a potential health and safety risk to children in care.
POC Due Date: 12/12/2024
Plan of Correction
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Licensee will remove/ replace mattresses by the due date: 12/12/2024.
Proof of correction will be submitted to Department via email.
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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At 10:20AM., Based on record review, LPA confirmed staff's proof of required immunization missing from facility files. This poses a potential health and safety risk to children in care.
POC Due Date: 01/10/2025
Plan of Correction
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Licensee will ensure staff proof of required immunization are stored in facility records by due date: 1/10/2025.
Proof of correction will be submitted to the Department via email.
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:Marie Rodriguez
TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME:Luis Gomez
TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 12/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/10/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/10/2024 01:46 PM - It Cannot Be Edited


Created By: Luis Gomez On 12/10/2024 at 11:21 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: PINHEIRO, ALEXANDRE
FACILITY NUMBER: 384002537

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/10/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(c)(2)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility. The Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be maintained in the infant’s file and shall be available to the Department for review.

This requirement is not met as evidenced by:
Deficient Practice Statement
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At 9:45AM., Based on record review, LPA confirmed Individual Infant Sleeping Plan (LIC9227) missing from qualifying infant files (C4, C6). This poses a potential health and safety risk to children in care.
POC Due Date: 12/12/2024
Plan of Correction
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Licensee will ensure completed LIC9227, Individual infant sleeping plan, are stored in facility records by the due date: 12/12/2024. Proof of correction will be submitted to the Department via email.
Type B
Section Cited
CCR
102370(d)
(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility:


This requirement is not met as evidenced by:
Deficient Practice Statement
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At 10:50PM., Based on record review and interview, LPA confirmed adult occupant in home without proper criminal record clearance in Guardian. This poses a potential health and safety risk to children in care.
POC Due Date: 12/12/2024
Plan of Correction
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Licensee will contact Guardan to ensure adult in home receives clearance prior to living at address.
Proof of correction will be submitted to the Department via email.
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:Marie Rodriguez
TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME:Luis Gomez
TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 12/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/10/2024


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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: PINHEIRO, ALEXANDRE
FACILITY NUMBER: 384002537
VISIT DATE: 12/10/2024
NARRATIVE
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(PAGE 2)
At 9:20AM., LPA inspected the outdoor play yard. Yard was completed fenced, with playthings in good repair. Canopy has been properly anchored. Home does not have any pools; fishpond; jacuzzi; or other bodies of water.

At 9:40AM., LPA reviewed facility records including the children and staff files.
The children’s files were reviewed and included the: Identification and Emergency Information (LIC700).

At 9:45AM., Based on record review, LPA confirmed Individual Infant Sleeping Plan (LIC9227) missing from qualifying infant files.

LPA reminded licensee to ensure children's immunization records are stored in facility file. Advisory Note: Technical Violation (LIC9102TV) was issued.

The staff file was reviewed and included personnel’s Notice of Employee Rights (LIC9052).

At 10:20AM., Based on record review, LPA confirmed staff's proof of required immunization missing from facility files.

At 10:50PM., Based on record review and interview, LPA confirmed adult occupant in home without proper criminal record clearance in Guardian.

LPA reminded licensee to renew expired mandated reporter training course (AB1207). Advisory Note: Technical Violation (LIC9102TV) was issued.
Licensee’s cardiopulmonary resuscitation (CPR)/ Pediatric First Aid Certification was current, expiring: 9/2026.

Facility is conducting emergency disaster drills every six months, with last drill completed on 8/8/2024.

The required forms are posted in entry and include the: License; Notification of Parent’s Rights (PUB379); and Written Emergency Disaster Plan (LIC610).

Per licensee, isolation of an ill child is in the Dining Area.


(REFER TO 809C, FOR CONT.)
SUPERVISOR'S NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2024
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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: PINHEIRO, ALEXANDRE
FACILITY NUMBER: 384002537
VISIT DATE: 12/10/2024
NARRATIVE
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(PAGE 3)
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.

LPA discussed safe sleep regulations with licensee and the 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.



Facility 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.(REFER TO 809C., FOR CONT.)
SUPERVISOR'S NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2024
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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: PINHEIRO, ALEXANDRE
FACILITY NUMBER: 384002537
VISIT DATE: 12/10/2024
NARRATIVE
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(PAGE 4)
Based on today's inspection, deficiencies were observed in areas evaluated according to California Title 22, Div. 12 Chap. 3, Health and Safety Code of Regulations and cited on 809D. An exit interview, plan for correction, and facility evaluation report was discussed with Licensee, Alexandre Pinhero.
Licensee’s signature of this form acknowledges the receipt of these documents.

During exit interview, licensee confirmed no registered sex offenders are living in the facility, and LPA completed RSO profile. Notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2024
LIC809 (FAS) - (06/04)
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