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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414000300
Report Date: 11/02/2023
Date Signed: 11/02/2023 05:08:55 PM


Document Has Been Signed on 11/02/2023 05:08 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:AGUADO, SUSAN & CARMICHAEL, CHRISTINEFACILITY NUMBER:
414000300
ADMINISTRATOR:S. AGUADO & C. CARMICHAELFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 572-2411
CITY:SAN MATEOSTATE: CAZIP CODE:
94402
CAPACITY:12CENSUS: 8DATE:
11/02/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Susan Aguado, Christine CarmichaelTIME COMPLETED:
05:10 PM
NARRATIVE
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On 11/2/2023 at 1:50PM., Licensing Program Analysts (LPA), Luis J. Gomez met with Licensee, Susan Aguado. Purpose of the inspection was explained and was for an Unannounced; Annual Random. Licensee, Christine Carmichael arrived during inspection. Present was the licensee and two helpers caring for 8 children. Adults present have criminal record clearances on file. Licensee’s home is a 5 bedroom, 3 bathroom, 2 level house. Days and hours of operation are Monday- Friday, 8:00AM- 5:30PM. Day-care area are: Lower Level: Living Room (Playroom); Family Room (Napping Only); Bathroom #1; and Outdoor Play Yard. Off-limit area are: Lower Level: Kitchen; Living Room #2; Garage and Entire 2nd Level. LPA inspected home, inside and outside, with licensee for health and safety hazards.

At 2:00PM., the following was observed: Facility was clean, orderly, with age-appropriate playthings available for the children. Floors/ground was clear of obstructions or potential hazards. Accessible furniture, toys, and books were in good repair. Added storage is available for children belongings. Playroom has child sized tables and chairs for seated activities. For napping services, LPA observed several cots, and play pens available in facility. Play pens inspected were equipped with tight-fitting sheet and properly sized mattress.

LPA reminded licensee to ensure door to napping room remains open while children nap. Advisory Note: Technical Violation (LIC9102TV) was issued.

The off-limit areas have been made inaccessible. Bathroom #1 was clean, with supplies for hand washing. Poisons, detergents, cleaning compounds, medicine, and other items which poses a danger, have been made inaccessible to children. Facility was the proper temperature, with sufficient ventilation and lighting. Home had functioning telephone service; smoke detector, carbon monoxide detector; and fire extinguisher: 3A:40:BC, fully charged. (REFER TO 809C, FOR CONT)

SUPERVISOR'S NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 11/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/02/2023
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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Document Has Been Signed on 11/02/2023 05:08 PM - 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066


FACILITY NAME: AGUADO, SUSAN & CARMICHAEL, CHRISTINE
FACILITY NUMBER: 414000300

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/02/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102416.5(a)
Staffing Ratio and Capacity
(a) The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time.

This requirement is not met as evidenced by:
Deficient Practice Statement
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At 3:50PM., Based on observations, interview and record review, LPA confirmed facility operating beyond the capacity limit stated on the license, with 6 infant- age children in care. This poses an immediate health and safety risk to children in care.
POC Due Date: 11/03/2023
Plan of Correction
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Licensee will reduce enrolled capacity to required limit by the due date: 11/3/2023.
Proof of correction will be submitted to the department via email.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 11/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/02/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/02/2023 05:08 PM - 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066


FACILITY NAME: AGUADO, SUSAN & CARMICHAEL, CHRISTINE
FACILITY NUMBER: 414000300

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/02/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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At 3:30PM., Based on record review, LPA confirmed licensee has not completed the Mandated Reporter Training Certification (AB1207). This poses a potential health and safety risk to children in care.
POC Due Date: 11/13/2023
Plan of Correction
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Licensee will completed mandated reporter training course, AB1207 by the due date: 11/13/2023.
Proof of correction will be submitted to the department via email.
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
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At 3:40PM., Based on record review, LPA confirmed Individual Infant Sleeping Plans, LIC9227, missing for qualifying children in care. This poses a potential health and safety risk to children in care.
POC Due Date: 11/06/2023
Plan of Correction
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Licensee will ensure children missing LIC9227, Individual infant sleeping plans are stored in children files by due date: 11/6/2023.
Proof of correction will be submitted to the department via email
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: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 11/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/02/2023
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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: AGUADO, SUSAN & CARMICHAEL, CHRISTINE
FACILITY NUMBER: 414000300
VISIT DATE: 11/02/2023
NARRATIVE
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(Page 2)
At 2:25PM., LPA reviewed the outdoor play yard. Yard was completely enclosed.
LPA inspected facility’s on-site pool. LPA observed tarp covering installed over top of the pool. Per licensee, tarp is bolted, and cannot be removed. Licensee stood on covering during inspection. Playthings inspected were in good repair.

At 2:45PM, LPA reviewed facility records including the children’s files and personnel files. Personnel files were reviewed.

At 3:30PM., Based on record review, LPA confirmed licensee has not completed the Mandated Reporter Training Certification (AB1207).

At 3:35PM., Based on record review, LPA confirmed staff proof of immunization missing from facility records. Advisory Note: Technical Violation (LIC9102) was issued.

Children’s files were reviewed and included the: Notification of Parent's Rights (LIC995); Identification of Emergency Information (LIC702); Immunization Records; and Health History.

LPA confirmed day-care child, C1, file missing from the facility records. Advisory Note Technical Violation (LIC9102TV) was issued.

At 3:40PM., Based on record review, LPA confirmed Individual Infant Sleeping Plans, LIC9227, missing for qualifying children in care.

LPA reminded licensee to document, napping conditions for every 15 minute review for all infants in care. Advisory Note: Technical Violation (LIC9102TV) was issued.

At 3:50PM., Based on observations, interview and record review, LPA confirmed facility operating beyond the capacity limit stated on the license, with 6 infant- age children in care.



Licensee's Cardiopulmonary Resuscitation (CPR)/ First Aid certification was current, expiring: 12/2024.

Licensee is conducting and emergency disaster drills every six months, with last drill completed on: 9/15/2023, properly logged. LPA advised licensee to document entire date for each drilled conducted.

Required forms are posted in entry way, including the Childcare License; Notification of Parent’s Rights (PUB379); and Emergency Disaster Plan (LIC610A). (REFER TO 809C, FOR CONT.)
SUPERVISOR'S NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2023
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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: AGUADO, SUSAN & CARMICHAEL, CHRISTINE
FACILITY NUMBER: 414000300
VISIT DATE: 11/02/2023
NARRATIVE
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(Page 3)
Per licensee, isolation of an ill children is in the playroom.
Per licensee, she provides food service for children in care. LPA advised licensee to ensure all children’s food containers brought by families are be labeled. Per licensee, home does not have any firearms.

Licensee was reminded that all adults 18 years and over living in the home, person who provides care and supervision to children, and staff who have contact with children, including employee and volunteers, except as specified in Health and Safety Code section 1596.871, 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 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 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.



Licensee was informed of the www.mychildcareplan.org site is a consumer education website that helps families obtain child care by connecting to child care providers and resources and referral agencies (R&R) throughout California.

Incidental Medical Services (IMS) policy was discussed. For IMS information, see PIN 20-02-CCP. When an IMS is provided, a plan for 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- 0382 (TTY) and link to publications: Commonly asked questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm (REFER TO 809C, FOR CONT.)
SUPERVISOR'S NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2023
LIC809 (FAS) - (06/04)
Page: 8 of 9
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: AGUADO, SUSAN & CARMICHAEL, CHRISTINE
FACILITY NUMBER: 414000300
VISIT DATE: 11/02/2023
NARRATIVE
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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 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. Exit interview was conducted with licensee, Christine Carmichael. Licensee’s signature of this form acknowledges receipt of these documents.

Type “A” violations were issued today. Licensee was advised to provide a copy of the Evaluation Report and all Type “A” Deficiencies cited, to parents and guardians of children currently enrolled in care and to parents of newly enrolled children during the next 12 months. A signed and dated LIC 9224 (Deficiency and Acknowledgment of Receipt of Licensing Reports) shall be maintained in all children's files.

During exit interview, licensee, Christine Carmichael, confirmed that there are no registered sex offenders living in the facility, and LPA completed the RSO profile. Notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2023
LIC809 (FAS) - (06/04)
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