414001089-7-19-2023-05-CC-CQUO-CTVSC7-20230719134505

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414001089
Report Date: 07/19/2023
Date Signed: 07/19/2023 01:45:09 PM

Document Has Been Signed on 07/19/2023 01:45 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:	MUNOZ, TERRI ANN		FACILITY NUMBER:	414001089
ADMINISTRATOR:	MUNOZ, TERRI ANN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 834-0181
CITY:	SAN BRUNO	STATE: CA	ZIP CODE:	94066
CAPACITY:	14	CENSUS: 9	DATE:	07/19/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:05 AM
MET WITH:	Terri Ann Munoz		TIME COMPLETED:	02:00 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 July 19, 2023 at approximately 11:05am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, annual inspection. LPA met with licensee, Terri Ann Munoz, and explained the purpose of the inspection. Present during LPA's visit included licensee, an assistant (A1) and 9 enrolled children (2 infants, 1 school age, and 6 preschool age). Licensee is operating within capacity limits and ratio during LPA's visit. Licensee lives in the home with their adult son. All adults living and/or working in the home have fingerprint clearance on file. Hours of operation are Monday through Friday 8:30am to 4:30pm. The DAY CARE AREAS are located on the ground level only which includes playroom #1, playroom #2, nap room, bathroom #1, deck and backyard. The OFF LIMIT AREAS are the garage and the entire second level. Off limit areas are made inaccessible with child safety gates. LPA toured day care areas with the licensee. LPA observed the 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. Flooring in playrooms include carpeting that was observed to be clean. Bathroom for children's use was observed to be in proper working condition, equipped with appropriate sanitation products. Cabinet in bathroom was not observed to have any hazards or poisons. LPA observed cleaning solutions and poisons are stored in facility's high shelves, inaccessible to children. Nap room for infants was also observed to be clean. Electrical outlets are made inaccessible with child safety covers. Home is equipped with a fully charged fire extinguisher and a working dual smoke/carbon monoxide detector. (Continue Report on Page 2...)

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2023

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: MUNOZ, TERRI ANN	FACILITY NUMBER: 414001089
	VISIT DATE: 07/19/2023

NARRATIVE

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Entire backyard is fully enclosed and fenced. The outdoor deck is also fully fenced and enclosed. There are stairs in the backyard that have a child safety gate. LPA observed outdoor area to be equipped with appropriate outdoor toys and materials that were in good condition. LPA did not observe any pools, spas or bodies of water on site.

LPA reviewed 9 children's files, which were complete. Children's files have a record of identification information on file. Licensee and A1 have a current CPR/First Aid certificate that will expire 07/2025. Emergency drills are properly logged and maintained. Last emergency drill was conducted 06/20/2023. Licensee has licensing documentation that is properly posted and available for review. Licensee maintains a child care roster that was also made available for review. Per licensee, there are no weapons or firearms in the home. There is a dog in the home that stays in an off limit area, separate from children in care.

LPA reminded licensee about Mandated Reporter training available www.mandatedreporterca.com. Licensee was reminded Mandated Reporter training must be renewed every 2 years and all staff whom directly work with children must complete training.

Licensee was reminded, as of September 1, 2016, all Staff and Volunteers must provide proof of immunization against pertussis, measles, and influenza, or qualifies for an exemption, pursuant to Health and Safety code 1596.7995 and 1597.622.

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 Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2023

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: MUNOZ, TERRI ANN	FACILITY NUMBER: 414001089
	VISIT DATE: 07/19/2023

NARRATIVE

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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, Terri Ann Munoz, 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.

Exit interview conducted and report was reviewed with the licensee, Terri Ann Munoz.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2023

LIC809 (FAS) - (06/04)

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