414000981-4-17-2025-05-CC-DALO-DFTP69-20250417110157

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414000981
Report Date: 04/17/2025
Date Signed: 04/17/2025 11:02:22 AM

Document Has Been Signed on 04/17/2025 11:02 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:	POZZI, CAMILLE M.		FACILITY NUMBER:	414000981
ADMINISTRATOR/ DIRECTOR:	POZZI, CAMILLE M.		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 588-2749
CITY:	SOUTH SAN FRANCISCO	STATE: CA	ZIP CODE:	94080
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 1	DATE:	04/17/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:45 AM
MET WITH:	Camille Pozzi		TIME VISIT/ INSPECTION COMPLETED:	11:20 AM

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 4/17/2025 LPA Alvarado conducted an unannounced annual inspection at the facility. LPA Alvarado attempted an annual inspection on 11/25/2024. Entrance to the facility is in the lower level of the home, around the driveway. LPA Alvarado met with the licensee Camille Pozzi (L1) at approximately 8:45. Present in the household is the licensee supervising one child, who is (L1) niece. (L1) stated that, the facility was closed for the day and is only supervising the niece for the day. Present also is the House cleaner who is in a off limit area of the home. Facility also has a dog, that is located in off limit areas while children are in care. Everyone in the household is fingerprinted and associated to the facility. Daycare Areas: Family Room, Kitchen, and Outdoor Play area. Off-limits Areas: Entire second level of the home and Garage LPA Alvarado and (L1) inspected the home for any health or safety hazards. The home is equipped with a fully charged 2A10BC fire extinguisher. There is a duo carbon monoxide and fire detector that were demonstrated to be operational during the visit. There is a fireplace in the Family Room that has been barricaded to be inaccessible. Electrical outlets are covered or blocked by furniture when not in use. LPA observed there to be age-appropriate toys and learning materials present. Furniture is age-appropriate and free of rough or sharp edges. Children nap in cribs and mats that are provided by the facility. Per (L1), the facility provides breakfast, lunch and snack, LPAs reviewed one child’s record and facility records. (L1) CPR/First Aid is current taken on 11/2024 Expiring 11/2026. Mandated Reporter Training has a portion completed. (L1) was reminded the CPR/First Aid Training and Mandated Reporter Training is to be renewed every two years. Continued on Page 2...

Ali Zebila	TELEPHONE: (650) 730-4140
Diana Alvarado	TELEPHONE: 650-266-8800
	DATE: 11/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2024

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: POZZI, CAMILLE M.	FACILITY NUMBER: 414000981
	VISIT DATE: 04/17/2025

NARRATIVE

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LPAs advised that a facility roster of enrolled children must be maintained. Per (L1), emergency drills have not been conducted or logged. LPAs advised that emergency drills must be conducted and logged at least once every six months.

Children’s records were observed to be complete. LPAs advised that an Individual Infant Sleeping Plan (LIC9227) must be maintained for all children under 12 months of age. Infant sleeping logs are to be maintained for all infants (0-24 months of age). Safe sleep was discussed with (L1) and Infant Safe Sleep Regulations were provided.

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.

Facility representative 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 facility representative 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 facility representative 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.

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SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 730-4140
LICENSING EVALUATOR NAME: Diana Alvarado	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2025

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: POZZI, CAMILLE M.	FACILITY NUMBER: 414000981
	VISIT DATE: 04/17/2025

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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/.

Facility representative 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, facility representative confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

See LIC809-D for deficiencies cited today. See LIC9102-TV for technical violations issued today. See LIC9102-TA for Technical Assistance issued today. Appeal rights were provided and explained to (L1). A notice of site visit was provided and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Camille Pozzi.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 730-4140
LICENSING EVALUATOR NAME: Diana Alvarado	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/17/2025 11:02 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: POZZI, CAMILLE M.	FACILITY NUMBER: 414000981
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/17/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

CCR

102425(j)(2)

Infant Safe Sleep

The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above the licnesee has not maintained the Documented 15 Minute Infant Safe Sleep Logs in one out of one person which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/02/2025
	Plan of Correction
1 2 3 4	Licensee will ensure to document Infat Safe sleep for Infants under 24 Months. Licensee will submitt Via email to LPA Alvarado by 5/2/2025 documentation of the Infant Sleep Logs. LPA Alvarado will conduct a follow up Inspection to ensure that Logs are being maintained.

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.

Ali Zebila	TELEPHONE: (650) 730-4140
Diana Alvarado	TELEPHONE: 650-266-8800
	DATE: 04/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2025

LIC809 (FAS) - (06/04)

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