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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414001645
Report Date: 09/20/2024
Date Signed: 10/10/2024 11:39:18 AM


Document Has Been Signed on 10/10/2024 11:39 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:CORBETT, GEORGINAFACILITY NUMBER:
414001645
ADMINISTRATOR:CORBETT, GEORGINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 995-6435
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94063
CAPACITY:14CENSUS: 4DATE:
09/20/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Licensee, Georgina CorbettTIME COMPLETED:
12:00 PM
NARRATIVE
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On October 10th, 2024 at approximately 9:05am, Licensing Program Analyst (LPA) Tapia-Mandujano conducted an unannounced required annual inspection. Purpose of the inspection was explained. LPA was let in by assistant, Brenda Milian and licensee arrived at the facility about 15 mins. later. LPA explained the purpose of the inspection to Licensee, Georgina Corbett. Present in the facility were licensee, assistant, and an unfingerprinted adult supervising 4 children (3 infants, and 1 preschool age). Not all adults living and/or working at the facility have criminal record clearance and/or are associated. Type A citation was issued.

Licensee owns 3 bedrooms, 2.5 bathroom, single level house. Licensee has pet cats, who are maintained in off limit areas. The hours of operation are Monday-Friday from 8am-5pm. Daycare areas are: Living Room, Daycare Room, Bathroom #0.5 (in Daycare room), and portion of the backyard. Off Limit areas are: Bedroom #1, #2, #3, and Bathroom #1 and #2, Kitchen (pass by only), Garage, and side yards. All off limit areas are properly barricaded.

LPA observed home to be clean and in good repair with proper temperature and ventilation. There were a variety of age appropriate toys and equipment in the home which were in good condition. Home does not have a fireplace. There is a pet cat that is separate from children in care with proper documentation. There were no pools, spas or bodies of water on the property. All cleaning supplies, poisons and other chemicals were stored inaccessible to children. Discipline Policy was discussed. Isolation Area for sick children is the Daycare room/living room/Kitchen depending on the where the majority of children are.

There was a fully charged fire extinguisher, smoke alarm and carbon monoxide alarm, and a working telephone on site. Phone number listed for Licensee is current. Per Licensee, there are no weapons or firearms in the home. Infant children are sleeping in cribs in the living room. Licensee was unable to show LPA that sleep logs are maintained. Type B citation was issued.


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SUPERVISOR'S NAME: Marie RodriguezTELEPHONE: (650) 732-0619
LICENSING EVALUATOR NAME: Leslit Tapia-MandujanoTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 06/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/26/2024
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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Document Has Been Signed on 10/10/2024 11:39 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: CORBETT, GEORGINA
FACILITY NUMBER: 414001645

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/20/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1596.871(c)(1)(A)
Administration of Child Day Care Licensing
Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision(f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above as there is an adult present that does not have fingerprint clearance on file which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/11/2024
Plan of Correction
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Licensee will ensure that all adults living and/or working in the facility will have fingerprint clearance and are associated prior to being present in the facility.
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) 732-0619
LICENSING EVALUATOR NAME: Leslit Tapia-MandujanoTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 10/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/10/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/10/2024 11:39 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: CORBETT, GEORGINA
FACILITY NUMBER: 414001645

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/20/2024

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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Based on interview and record review, the licensee did not comply with the section cited above as both licensee's and assistants Mandated Reporter training expired in April 2024 which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/25/2024
Plan of Correction
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Licensee understands that mandated reporter must be taken every 2 years.

Licensee and assistant will renew certificate and send proof to LPA Tapia-Mandujano via email by 10/25/24.
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above as licensee cannot show proof of immunizations for assistant which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/25/2024
Plan of Correction
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Licensee will ask assistant for record of required immunization and submit proof to LPA Tapia-Mandujano via email by 10/25/24.
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) 732-0619
LICENSING EVALUATOR NAME: Leslit Tapia-MandujanoTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 10/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/10/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/10/2024 11:39 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: CORBETT, GEORGINA
FACILITY NUMBER: 414001645

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/20/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102421(a)
Child's Records
(a) The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above as the children's files are incomplete and missing documents which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/25/2024
Plan of Correction
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Licensee will ensure that every child enrolled has all required documents that are completed fully and signed by parents.

Licensee will submit proof of all record files and submit to LPA Tapia-Mandujano via email by 10/25/24.
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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Based on record review, the licensee did not comply with the section cited above as there are three infant children that do not have the LIC 9227 on file which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/25/2024
Plan of Correction
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LPA explained the safe sleep regulations to licensee.

Licensee will ensure that all parents of childen under 12 months complete and sign the required form.
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) 732-0619
LICENSING EVALUATOR NAME: Leslit Tapia-MandujanoTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 10/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/10/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/10/2024 11:39 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: CORBETT, GEORGINA
FACILITY NUMBER: 414001645

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/20/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)(D)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above as licensee could not show LPA that the sleep logs are maintained daily which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/18/2024
Plan of Correction
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LPA suggested a different method of maintaining sleep logs.

Licensee will show proof of maintaining logs for a week and send proof of completion to LPA Tapia-Mandujano via email by 10/18/24.
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) 732-0619
LICENSING EVALUATOR NAME: Leslit Tapia-MandujanoTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 10/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/10/2024
LIC809 (FAS) - (06/04)
Page: 5 of 7


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: CORBETT, GEORGINA
FACILITY NUMBER: 414001645
VISIT DATE: 09/20/2024
NARRATIVE
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LPA reviewed the 4 children's file and facility files. Both children files and facility files are incomplete. Type B citation was issued. Licensees CPR & First Aid Certificate expires on 06/2025. Licensee's Mandated Reporter Certificate has since expired. Type B citation was issued. Last Emergency drill was 06/2024. Licensee is conducting Emergency Drills at least once every six months and properly logging the drills. All the required posting documentation, such as the facility license, Notification of Parental Rights have been placed in a prominent area for parents or representatives to review.

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 atwww.cdss.ca.gov/inforesources/community-care-licensing/inspection-process

Licensee was reminded that all adults 18 and over, 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 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 the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/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.



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SUPERVISOR'S NAME: Marie RodriguezTELEPHONE: (650) 732-0619
LICENSING EVALUATOR NAME: Leslit Tapia-MandujanoTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024
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: CORBETT, GEORGINA
FACILITY NUMBER: 414001645
VISIT DATE: 09/20/2024
NARRATIVE
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Page 3 Continued...

Incidental Medical Services (IMS) policy was discussed. Licensee does not offer IMS at this time. 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, Georgina Corbett, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS on 10/10/24.

***California Code of Regulations, (Title 22, Div. 12, Ch 3) were cited on this day.



Three type “A” violations were issued today. Licensee is advised to provide a copy of the Evaluation Report and all Type “A” Deficiencies cited, to the 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 shall be maintained in all Children's files. Notice of site Visit will be posted and should remain posted for 30 days, failure to post will result in an immediate civil penalty.

Exit interview conducted and report was reviewed with the licensee, Georgina Corbett.
SUPERVISOR'S NAME: Marie RodriguezTELEPHONE: (650) 732-0619
LICENSING EVALUATOR NAME: Leslit Tapia-MandujanoTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024
LIC809 (FAS) - (06/04)
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