414001690-9-14-2023-05-CC-CQUO-CVNP7G-20230914110356

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414001690
Report Date: 09/14/2023
Date Signed: 09/14/2023 11:04:05 AM

Document Has Been Signed on 09/14/2023 11:04 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:	VARGAS, CLAUDIA PATRICIA		FACILITY NUMBER:	414001690
ADMINISTRATOR:	VARGAS, CLAUDIA P.		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 846-2494
CITY:	COLMA	STATE: CA	ZIP CODE:	94014
CAPACITY:	14	CENSUS: 9	DATE:	09/14/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Claudia Vargas		TIME COMPLETED:	11:15 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 September 14, 2023 at approximately 8:15am, Licensing Program Analyst (LPA) Catrina Quimbo, conducted an unannounced, annual inspection. LPA met with licensee, Claudia Vargas, and explained the purpose of the inspection. At start of LPA's visit, children were arriving to home. Licensee stated they live in the multi-level home with their husband and sister-in-law. Per licensee, there are no weapons or firearms in the home. Hours of operation are Monday to Friday 8:00am to 5:00pm. After drop off period, there are 9 children (4 infants, 5 preschool age), 2 assistants and licensee present. Licensee is operating within capacity limits and ratio during LPA's visit. All adults living and/or working in the home have fingerprint clearance on file. Entrance to the daycare is through the side gate. The DAY CARE AREAS are located on the ground floor of the home only that includes the kitchen, bedroom #1 (nap room), bedroom #2 (activity/nap room), living room, bathroom and backyard. The OFF LIMIT AREAS are the garage and entire second level of home. Off limit areas are made inaccessible with closed doors. LPA toured day care areas of home with licensee. LPA observed 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. LPA observed electrical outlets to be made inaccessible with child safety covers. Home is equipped with a fully charged fire extinguisher and a dual smoke/carbon monoxide detector. During visit, licensee tested detector located in kitchen. LPA observed kitchen cabinets to have child safety locks installed. Bathroom for children's use was observed to be in proper working condition. LPA did not observe any hazardous materials to be accessible to children in bathroom cabinets. Entire backyard is fully fenced and enclosed. Flooring in backyard includes padding for additional safety that was observed to be in good condition. Outdoor area is equipped with toys and materials that were observed to be in good condition. (Continue Report on Page 2...)

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023

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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: VARGAS, CLAUDIA PATRICIA	FACILITY NUMBER: 414001690
	VISIT DATE: 09/14/2023

NARRATIVE

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Bedrooms utilized for sleeping children were observed to be clean. Flooring in children's bedroom #2 includes additional padding that was observed to be clean. LPA observed bedrooms to include cribs and mats for napping children. LPA observed cribs to be free of any loose articles or materials. LPA did not observe cribs to have any bumper pads, pillows or blankets. Licensee maintains sleeping logs for napping infants under 12 months, that includes the 15 minute time checks. LPA reminded licensee sleeping logs must be maintained for all infants under 24 months.

LPA reviewed 8 children's records, whom were present during LPA's visit. Upon LPA's review, 6 of the 8 children present, did not have an immunization record. Licensee stated they were planning to update children's files with updated immunization records during the month.

LPA reviewed license and licensee's two assistants' (A1 & A2) records. LPA observed all staff present have a current First Aid/CPR certification that will expire 07/2025. Assistants present also have their required immunizations that were made available for review. Licensee's Mandated Reporter certification is current and will expire 12/2023.

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

At approximately 10:30am, due to a pre-scheduled appointment, licensee temporarily left home. LPA discussed LPA's observations and review with licensee prior to licensee leaving home. LPA completed visit with licensee's assistant/facility representative, A1.

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.
(Continue Report on Page 3...)

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023

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: VARGAS, CLAUDIA PATRICIA	FACILITY NUMBER: 414001690
	VISIT DATE: 09/14/2023

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LPA discussed the safe sleep regulations with 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.

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 visit, the licensee, Claudia Vargas, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Of the 9 children present during LPA's visit, LPA reviewed 8 children's files. Of the 8 children, LPA did not observe immunization records for 6 children. Licensee was issued a Type B citation for incomplete children's records. LPA discussed citation and plan of correction with licensee prior to licensee leaving home.

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

Exit interview conducted and report was reviewed with the facility representative, A1.

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023

LIC809 (FAS) - (06/04)

Page: 3 of 4

Document Has Been Signed on 09/14/2023 11:04 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: VARGAS, CLAUDIA PATRICIA	FACILITY NUMBER: 414001690
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/14/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102418(a)

Immunizations

(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, record review, the licensee did not comply with the section cited above. 6 out of 9 children who were present, did not have an immunization record available for review, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/29/2023
	Plan of Correction
1 2 3 4	Licensee stated they will obtain updated immunization records from children's families. Licensee to provide LPA proof of missing children's immunization records no later than 09/29/2023 by 5:00pm.

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.

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023

LIC809 (FAS) - (06/04)

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