384004118-5-31-2024-05-CC-JYEE-D5SPFN-20240531111702

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384004118
Report Date: 05/31/2024
Date Signed: 05/31/2024 11:17:16 AM

Document Has Been Signed on 05/31/2024 11:17 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:	MORALES NOVA, GLORIA		FACILITY NUMBER:	384004118
ADMINISTRATOR:	MORALES NOVA, GLORIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 583-6450
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94112
CAPACITY:	14	CENSUS: 10	DATE:	05/31/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Dickmar Nova		TIME COMPLETED:	11:30 AM

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Licensing Program Analyst (LPA) Yee conducted an annual inspection today. Present at the facility are the licensee's husband, Mr. Nova, 3 staff members, and 10 children. The total number of children enrolled at the facility is 12. The facility personnel summary report was reviewed with Mr. Nova and updated during the visit. Per facility representative, the current residents are licensee, her husband, two children (5 yr. old and 9 yr. old). All adults living at the facility have fingerprint clearance.

Daycare: living room, dining room, front room (added during the visit), kitchen, bathroom next to the kitchen, and backyard. Downstairs room is no longer in use and eliminated during the visit. LPA reminded the facility's representative that any changes in the facility must be notified to the CCL office before making changes. The remaining areas of the house are off-limits. Helper has current CPR, 1ST until 04/2026.

LPA inspected the daycare areas for health and safety hazards. The facility is equipped with a fire extinguisher size 2A10BC. The smoke detector and carbon monoxide are available and working. The home is ventilated properly. The facility does not have bodies of water such as a 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 lunches and snacks. The last fire drill was conducted last year. However, date and documentation was not available. Roster was available.

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/.

Children files and staff files were reviewed.

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: 05/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2024

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: MORALES NOVA, GLORIA	FACILITY NUMBER: 384004118
	VISIT DATE: 05/31/2024

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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

The facility representative, Mr. Nova 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 facility's representative, Mr. Nova 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 facility representative, Mr. Nova.

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: 05/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 05/31/2024 11:17 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: MORALES NOVA, GLORIA	FACILITY NUMBER: 384004118
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/31/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(a)

Operation of A Family Child Care Home

(a) The licensee shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise the children during his/her absence. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, 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: 06/03/2024
	Plan of Correction
1 2 3 4	The Title regulations was explained to the facility representative and the licensee, Gloria on the phone. The facility needs to correct this deficiency by due date, 06/03/2024. 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: 05/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2024

LIC809 (FAS) - (06/04)

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