410502890-5-2-2023-05-CC-MOLN-CRFRXX-20230502132527

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 410502890
Report Date: 05/02/2023
Date Signed: 05/02/2023 01:25:43 PM

Document Has Been Signed on 05/02/2023 01:25 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:	COULSON, LARRY AND MARY		FACILITY NUMBER:	410502890
ADMINISTRATOR:	COULSON, MARY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 368-5262
CITY:	REDWOOD CITY	STATE: CA	ZIP CODE:	94061
CAPACITY:	14	CENSUS: 6	DATE:	05/02/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:40 AM
MET WITH:	Mary Coulson		TIME COMPLETED:	01:45 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 May 2, 2023. Licensing Program Analyst (LPA) Maria Olguin-Leon met with Licensee, Mary Coulson for an unannounced annual inspection. The purpose of the inspection was explained. Present today were Licensees, helper and 6 children (3 infants & 3 preschoolers). Licensee is operating within capacity and ratio requirements on this day. Licensee and helper have criminal record clearances on file with the department. Hours of operation are Monday– Friday, 7:00am to 5:00pm. LPA and Licensee toured the home for health and safety hazards. The home is a one story home. Day Care Areas: Entire home and backyard is used for daycare. Off Limits Areas: Is garage which is kept locked. The home is clean and has proper ventilation. Fireplace is barricaded with a sofa and inaccessible. Cleaning supplies and other potentially harmful items are stored underneath kitchen sink and in garage and inaccessible to children. There are plenty of age-appropriate toys, child size furnishings, learning material, sleeping mats and playpens. Licensee provides bedding and washes them on a weekly basis. Outdoor play area has plenty of toys and space for play. Backyard is completely fenced with a 5 ft. fence and off limits area is gated off. There are no pools, spas, or other bodies of water on the property. Licensee provides and cooks meals for children in care. LPA observed food to be properly stored to avoid contamination. The home is equipped with a dual carbon monoxide/smoke detector and a fully charged fire extinguisher located in living room. Isolation area for ill children is in kitchen or front porch away from other children. First aid kit is fully stocked with supplies. Home is equipped with a landline and Licensee has a cell phone. Per licensee there are no weapons or firearms in the home. LPA reviewed 5 children’s records and all required documents were in children’s files. Licensee and helper are registered for CPR/First Aid renewal on 05/13/2023. LPA reminded Licensee to complete Mandated Reporter training. Children’s roster was reviewed and is up to date. Last emergency drill was documented on 4/06/2023. Licensee has liability insurance through DCI Insurance. Cont. page 2...

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Maria Olguin-Leon	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2023

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: COULSON, LARRY AND MARY	FACILITY NUMBER: 410502890
	VISIT DATE: 05/02/2023

NARRATIVE

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

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. Where any IMS is provided a Plan for Providing 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 publication: Commonly Asked Questions and Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

The Licensee was reminded about the Provider Information Notices (PINs) on the CCLD website. Licensee was informed that as of September 1, 2016, a person may not be employed or volunteer at a childcare facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662. LPA reviewed AB 1207 with the Licensee. As of January 1, 2018, all staff must complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

LPA encouraged the Licensee to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. The Licensee can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

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 tools, please send them by email 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/inforesources/community-care-licensing/process.

Cont. page 3...

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Maria Olguin-Leon	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2023

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: COULSON, LARRY AND MARY	FACILITY NUMBER: 410502890
	VISIT DATE: 05/02/2023

NARRATIVE

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A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

As of today, no deficiencies were issued under CCR, Title 22, Division 12.

As of today, based on observation and file reviews, facility is currently in substantial compliance with title 22.

Exit interview conducted and report was reviewed with the licensee, Mary Coulson.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Maria Olguin-Leon	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2023

LIC809 (FAS) - (06/04)

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