384003070-6-28-2023-05-CC-LGOZ-CT8VW3-20230628164715

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384003070
Report Date: 06/28/2023
Date Signed: 06/28/2023 04:47:22 PM

Document Has Been Signed on 06/28/2023 04:47 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:	ROSILLO, ANGELINA A.		FACILITY NUMBER:	384003070
ADMINISTRATOR:	ROSILLO, ANGELINA A.		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 418-8563
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94110
CAPACITY:	14	CENSUS: 12	DATE:	06/28/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:40 PM
MET WITH:	Angelina Rosillo		TIME COMPLETED:	04:50 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 6/28/2023 at 1:40PM., Licensing Program Analysts (LPA), Luis J. Gomez met with Licensee, Angelina Rosillo. Purpose of the inspection was explained and was for an Unannounced; Annual Random inspection. Present in facility was the licensee and two assistants caring for 12 children (9 preschool age, 2 infant age, 1 school age). Adults have criminal record clearances on file. Licensee’s home is a three bedroom, two bathroom, two level house. Days and hours of operation are Mon- Fri, 8:00AM- 5:30PM. Daycare Areas are: 1^st Level: Living Room (Playroom); Bathroom #1; Bedroom #1 (Napping Only); Dining Area; and Outdoor Play Area. Off Limit Areas are: 1^st Level: Kitchen (Pass through only). Entire 2^nd Level: Bedroom #2; and Bathroom #2. LPA inspected facility, indoor and outdoors, with licensee for health and safety hazards. At 1:45PM., the following was observed: Facility was clean, orderly, with age-appropriate playthings available for the children. Floors/ground surfaces were clear of obstructions or possible hazards. Accessible furniture, blocks and books inspected were in good repair. Child sized table and chairs are available in Dining Area, for snack and seated activities. For napping services, LPA observed play pen and napping mats, stored in bedroom #1. LPA reminded licensee to ensure one crib/ play pen is available for each infant in care. Per licensee, napping sheets are washed weekly, on-site. The off-limit areas, including entire 2^nd level, have been made inaccessible with child safety gates. Bathroom #1 was maintained clean with and adequate supplies for hand washing. Fixture tested were in operating condition. Facility was the proper temperature, adequate ventilation, and lighting. Home had functioning cell phone service, smoke/ carbon monoxide combination detector and fire extinguisher, fully charged; size 2A10:BC, located in closet under staircase. At 2:10PM., LPA inspected facility outdoor play area. Area was enclosed, with playthings in good repair. Area is free of any hazardous plants with added shading available. Home does not have any pools, fishponds, jacuzzi, or bodies of water. (REFER TO 809C, FOR CONT)

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023

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: ROSILLO, ANGELINA A.	FACILITY NUMBER: 384003070
	VISIT DATE: 06/28/2023

NARRATIVE

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(Page 2)
At 2:35PM, LPA reviewed 3 personnel records, and 12 children’s records from the facility files. Personnel record were reviewed and included the: Employee Rights (LIC9052); Criminal Record Statement (LIC508); and Proof of Required Immunization.

LPA reminded licensee to the required 'Mandated Reporter Training Certifications (AB1207) are stored in facility files. Advisory Note: Technical Assistance (LIC9102TA) was issued.

Children’s files were reviewed and included the: Notification of Parent's Rights (LIC995); Affidavit regarding Liability Insurance (LIC282); Identification of Emergency Information (LIC702); Immunization Records; Individual Infant Sleeping Plans (LIC9227); and Consent for Medical Treatment (LIC627).

At 3:30PM., Based on record review and interview, LPA confirmed facility is not documenting infant napping conditions for each 15- minute review. Advisory Note: Technical Violation (LIC9102TV) was issued.

Licensees Cardiopulmonary Resuscitation (CPR)/ First Aid certification was current, expiring: 2/27/2025.

Facility is conducting emergency disaster drills every six months, with last drill done on 2/3/2023, properly logged.

Required posting are posted in facility, including the Childcare License; Notification of Parent’s Rights (PUB379), Emergency Disaster Plan (LIC610A); Per licensee, isolation of an ill children is in the playroom.

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

Children medication was reviewed.

Licensee was reminded all adults, 18 years and over, living or working in the home, including employee and volunteers, 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 up to $500.00 maximum per day/ per person will be assessed if this regulation is violated.

(REFER TO 809C, FOR CONT.)

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023

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: ROSILLO, ANGELINA A.	FACILITY NUMBER: 384003070
	VISIT DATE: 06/28/2023

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.

To improve the quality and value of the new inspection process, a survey will 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. LPA conducted exit interview with Angelina Rosillo, and licensees’ signature of this form acknowledges receipt of these documents.

Notice of today’s site visit was provided and must remain posted for 30 days.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023

LIC809 (FAS) - (06/04)

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