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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414001485
Report Date: 06/28/2024
Date Signed: 06/28/2024 11:56:14 AM


Document Has Been Signed on 06/28/2024 11:56 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:LOPEZ, ALICIAFACILITY NUMBER:
414001485
ADMINISTRATOR:LOPEZ, ALICIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 552-9464
CITY:MILLBRAESTATE: CAZIP CODE:
94030
CAPACITY:14CENSUS: 5DATE:
06/28/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:37 AM
MET WITH:Alicia Lopez, Miguel LopezTIME COMPLETED:
12:15 PM
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On June 28, 2024, Licensing Program Analysts (LPAs) Basak and Garcia conducted an announced annual inspection and met the Licensee, Alicia Lopez. LPAs explained to the Licensee the purpose of the inspection.
LPAs observed the licensee and two helpers supervising 5 children (infant and 4 preschool-age). The licensee complies with the licensing capacity. The children's roster has been reviewed and found to be complete and up to date.
LPA verified with the Guardian website all present adults have criminal clearance. According to the licensee, there are no changes to the previously approved childcare and off-limit areas.
Day Care Areas on the first floor: Playroom, nap room, kitchen, bathroom, and backyard. In the second floor LPAs observed a bedroom where only an infant sleeps there. LPAs observed all other parts of the home is off limit.
LPA observed home to be clean and in good repair with proper temperature and ventilation. LPAs observed all cleaning supplies, poisons, and other chemicals are stored inaccessible to children. There is a working smoke detector and carbon monoxide detector, a fully charged fire extinguisher in size of 2A. The home has a functioning telephone.

See page 2.
SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Zeynep BasakTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 06/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/28/2024
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: LOPEZ, ALICIA
FACILITY NUMBER: 414001485
VISIT DATE: 06/28/2024
NARRATIVE
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LPAs observed there are no bodies of water on the premises. Per Licensee, there are no firearms, gun, or weapon in the home. The operation hours of Child Care Home are Monday - Friday from 7:30 am to 5:30 pm. The facility provides breakfast, lunch, afternoon snack and drinking water to the children.
LPAs and the Licensee inspected the childcare areas for health and safety hazards. The childcare area is clean and free from hazards. LPAs observed a daycare area is equipped with age-appropriate toys, books, and educational materials.
LPAs observed a crib, and highchairs at the facility. LPAs reminded the Licensee that highchairs are used only when children are eating/feeding.

Mats, and individual sheets were observed in the napping area and the licensee stated children bring their sheet/blankets from home and they take these on Fridays to be washed. LPAs confirmed with the licensee they have an isolation area for ill children.
No toys or pillows inside and no objects hanging above the crib were observed. LPAs discussed with the Licensee that all mattresses should be designed for the cribs and bedsheets should be tightly fitted. In addition, the Licensee was informed about the sleep log, to check the infant every 15 minutes during naptime. The Licensee understood that no baby walkers, bouncers, or other similar items are permissible to be used during daycare hours.

See page 3.
SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Zeynep BasakTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2024
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: LOPEZ, ALICIA
FACILITY NUMBER: 414001485
VISIT DATE: 06/28/2024
NARRATIVE
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The Licensee CPR & First Aid and the licensee and the helper have valid certifications and Mandated Reporter training. Per the Licensee, the fire and earthquake drills are conducted every six months, and the latest drill was conducted in December 2023
LPAs reviewed the children's files and verified all required records were in the file, including Immunization records, Emergency cards, and Parental rights forms. Capacity options were discussed, and the Licensee acknowledges that care cannot be provided over the capacity specified on the license.
The requirements for reporting suspected child abuse, as well as reporting requirements for unusual incidents, were discussed. LPAs observed all mandatory postings are posted in Child Care Home including License, Parent's Rights poster, and Earthquake preparedness Checklist.
The 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.
LPAs discussed the safe sleep regulations with the licensee and discussed the Child Care Licensing Safe Sleep webpage https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource.

See page 4.
SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Zeynep BasakTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2024
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: LOPEZ, ALICIA
FACILITY NUMBER: 414001485
VISIT DATE: 06/28/2024
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LPA also informed the 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 Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: www.ada.gov/childqanda.htm.
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.
LPAs reviewed AB 1207 with the Licensees. 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.
Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families find childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.
See page 5.
SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Zeynep BasakTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2024
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: LOPEZ, ALICIA
FACILITY NUMBER: 414001485
VISIT DATE: 06/28/2024
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During the exit interview, the Licensee, Alicia Lopez, confirmed that there are no Registered Sex Offenders living in the facility. and LPAs completed the RSO profile in FAS.

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

An exit interview was conducted, and the report and appeal rights were reviewed with the licensee, Alicia Lopez.
SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Zeynep BasakTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2024
LIC809 (FAS) - (06/04)
Page: 5 of 5