384002608-3-21-2024-05-CC-JYEE-D3KPP5-20240321112857

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384002608
Report Date: 03/21/2024
Date Signed: 03/21/2024 11:29:27 AM

Document Has Been Signed on 03/21/2024 11:29 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:	CARINO, ELLEN-GRACE & CEPHAS		FACILITY NUMBER:	384002608
ADMINISTRATOR:	CARINO, ELLEN-GRACE&CEPHAS		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 267-0853
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94112
CAPACITY:	14	CENSUS: 11	DATE:	03/21/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Ellen-Grace Carino		TIME COMPLETED:	11:45 AM

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	An annual inspection was conducted by Licensing Program Analyst (LPA) Yee today. Helper opened the door. The purpose of the visit was explained. Present at the facility are the licensee, Ellen, 2 helpers, and 11 children (2 infants). The total children enrolled at the facility is 12 children. The facility personnel summary report was reviewed with Ellen and she said it is correct. Per license, the current residents are Ellen, her husband, her mom, sister, brother and their children ages 13 year old, and 9 yr old. All adults living at the facility have fingerprint clearance. Daycare areas are(lower level): playroom, bathroom, and backyard. The remaining areas of the home are off-limits. The licensees CPR, 1ST AID is not available during the visit. However, one helper has current CPR, 1st aid. LPA inspected the daycare areas for health and safety hazards. The home is ventilated properly. However, the patio and backyard were not clean and orderly. After LPA pointed it out, the licensee clean up the areas. The facility is equipped with a fire extinguisher size 2A10BC, smoke detectors, and carbon monoxide. LPA did not observe bodies of water such as a swimming pool and/or hot tub in the home. All harmful objects such as chemicals, detergents, cleaning, and medications are made inaccessible to children in care. Electrical outlets have child protective covers in place making them inaccessible to children. All off-limit areas such as bedrooms, kitchen/bathroom cabinets/drawers are made inaccessible to children in care. First aid supplies are available for children. Disciplinary policy was discussed with Licensee today. The home has age-appropriate toys and equipment available for the children in care. The facility provides meals. The last fire drills conducted on 01-12-2024. The licensee said she did not keep a log sheet. The licensee has been advised to keep a log sheet moving forward to avoid future citation. LPA discussed the Mandated Reporter Training, AB1207 that was effective on 1/1/2018. All staff must take the training and keep the certificate on file. The training needs to be renewed once every 2 years. Child Abuse Mandated Reporter Training, AB1207. https://www.mandatedreporterca.com/. One staff does not have AB1207 on file. The staff took general training. The staff needs to take the correct class by the end of this month. continue next page.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer Yee	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2024

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: CARINO, ELLEN-GRACE & CEPHAS	FACILITY NUMBER: 384002608
	VISIT DATE: 03/21/2024

NARRATIVE

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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 the licensee and discussed the Child Care Licensing Safe Sleep webpage at
https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/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. Safe Sleep regulations were discussed and provided. Infant activities were discussed. LIC9227 form (infant under 1 year old) was discussed. Sleep log was discussed (infant, newborn to 2 year old must be checked every 15 mins and logged). A sample sleep log form was provided.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Sections 102417. When any IMS is provided, an updated Plan of Operation that includes 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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, Available at: http://www.ada.gov/childqanda.htm

Licensee, Ellen was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the licensee, Ellen was confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

A notice of site visit was given and must remain posted for 30 days.

An exit interview was conducted and the report was reviewed with the licensee, Ellen.

The licensee has advised any additional questions to call Office, M-F, 8 am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.cdss.ca.gov

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer Yee	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/21/2024 11:29 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: CARINO, ELLEN-GRACE & CEPHAS	FACILITY NUMBER: 384002608
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/21/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102418(a)

Immunizations

(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. Immunizations need to transfer to blue sheet and update.
	POC Due Date: 04/11/2024
	Plan of Correction
1 2 3 4	The licensee needs to correct the deficiency and follow up visit will be conducted

Type B

Section Cited

CCR

102425(c)

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. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/11/2024
	Plan of Correction
1 2 3 4	The licensee needs to correct the deficiency and follow up visit will be conducted

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: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer Yee	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/21/2024 11:29 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: CARINO, ELLEN-GRACE & CEPHAS	FACILITY NUMBER: 384002608
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/21/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(j)(2)(D)(b)

Infant Safe Sleep

Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Infant's name This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on the record reviews, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. Sleep log was not available.
	POC Due Date: 04/11/2024
	Plan of Correction
1 2 3 4	The licensee needs to correct the deficiency and follow up visit will be conducted.

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: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer Yee	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2024

LIC809 (FAS) - (06/04)

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