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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410509233
Report Date: 03/08/2024
Date Signed: 03/08/2024 11:37:57 AM


Document Has Been Signed on 03/08/2024 11:37 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:DI BENE, DIANE & LOUISFACILITY NUMBER:
410509233
ADMINISTRATOR:DI BENE, DIANEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 574-4565
CITY:SAN MATEOSTATE: CAZIP CODE:
94403
CAPACITY:12CENSUS: 6DATE:
03/08/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Lynn Di BeneTIME COMPLETED:
12:00 PM
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On February 8, 2024, at approximately 8:45 AM, Licensing Program Analyst (LPA) Janet Gil conducted an unannounced, annual inspection. LPA met with licensee’s daughter, Lynn Duri , and licensee Diane Di Bene. LPA Gil explained the purpose of the inspection. Present during LPA's visit included 1 infant and 5 preschool aged children. LPA Gil observed a dog. The pet has a file with documentation on needed vaccination. Licensee is a large license and is operating within capacity limits and ratio.

The hours of operation are Monday through Friday from 7:30am to 4:30pm. Both licensees live in the home, which is a multi-level, single family home. All individuals living and/or working in the home have a criminal record clearance on file.

Day Care Areas: first level of the home includes the living room, kitchen, bathroom, bedroom #1, bedroom #2, playroom #1, playroom #2 (garage), outside deck and backyard.

Off Limit Areas: The Entire second level of the home and shed located in backyard. Off limit areas are barricaded with child safety gates and/or locked doors.

LPA inspected day care areas of home with licensee. LPA observed home to be in good repair with proper temperature and ventilation. Home is equipped with a variety of toys and materials that were observed to be in good working condition. LPA did not observe any accessible cleaning supplies, poisons, and solutions in day care areas. LPA observed electrical outlets to be made inaccessible with safety covers. Home is equipped with a fully charged fire extinguisher and multiple dual fire and carbon monoxide detectors. LPA tested fire/carbon monoxide detector in room playroom #1, which was observed to be working. LPA did not observe any hazardous materials accessible. A fully stocked first aid is available for children in care. Safety locks are installed in all cabinets of the playrooms and kitchen. Per licensee’s daughter, there are no children with IMS plans and does have DCI liability insurance for the Day Care. Day Care does provide all food, snacks, and formula.

Bathroom for children's use was observed to be in proper working condition. LPA observed bathroom to include appropriate toileting equipment and sanitation products. LPA did not observe any hazardous materials to be accessible to children in bathroom.

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SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Janet GilTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 03/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/08/2024
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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: DI BENE, DIANE & LOUIS
FACILITY NUMBER: 410509233
VISIT DATE: 03/08/2024
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LPA observed licensee to utilizes play pens and mats for the children in care. The entire backyard is fully enclosed. Outdoor area is equipped with a variety of toys and materials. LPA did not observe pools, spas or bodies of water.

LPA reviewed five children records which were not complete. The child’s file has a record of emergency identification information and required immunization. Three children were missing Parent right signatures, and one infant was missing the LIC 9227. Licensee’s daughter will email forms to LPA Gil when available. LPA reviewed staff records for licensee which were not complete. Home Care facility was experiencing a power outage therefore licensee did not have any access to immunization record online. Licensee and Licensee’s daughter have CPR/First Aid that is current and will expire 03/12/2024 and are scheduled to both renew them next week. Licensee and license’s daughter Mandated Reporter training certification is also current and will expire 03/2026.

Licensee has licensing documentation properly posted and available for review. Licensee also maintains a childcare roster that was made available for review. Emergency disaster drills are conducted at least once every six months. Last disaster drill was conducted February 2024. Per licensee’s daughter, there are no weapons or firearms in the home.

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 CARE tools, please send email inquiries 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/inspection-process.

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.

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SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Janet GilTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2024
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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: DI BENE, DIANE & LOUIS
FACILITY NUMBER: 410509233
VISIT DATE: 03/08/2024
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LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at
https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When 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 about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

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

During the exit interview, the licensee’s daughter, Lynn Duri, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

No deficiencies were issued today during LPA's visit.

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

Exit interview conducted and report was reviewed with the licensee, Lynn Duri.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Janet GilTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2024
LIC809 (FAS) - (06/04)
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