414001700-3-23-2023-05-CC-CQUO-CQ7NHV-20230323102922

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414001700
Report Date: 03/23/2023
Date Signed: 03/23/2023 10:29:30 AM

Document Has Been Signed on 03/23/2023 10:29 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	KHO, MERIAM TUAZON		FACILITY NUMBER:	414001700
ADMINISTRATOR:	KHO, MERIAM T.		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 226-3900
CITY:	BELMONT	STATE: CA	ZIP CODE:	94002
CAPACITY:	14	CENSUS: 8	DATE:	03/23/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:20 AM
MET WITH:	Meriam Kho		TIME COMPLETED:	10:45 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 March 23, 2023 at approximately 8:20am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, annual inspection. LPA met with licensee, Meriam Kho, and explained the purpose of the visit. Present during LPA's visit included licensee, licensee's spouse, teacher assistant (TA) and 8 preschool children. Facility 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. Hours of operation are Monday to Friday 8:30am to 5:00pm. Licensee operates with children ages 3 years to 5 years old. LPA conducted a health and safety inspection inside and outside the home. The home is a single family home. Entrance to facility is through side gate. The DAY CARE AREAS are the living room (main classroom), bedroom #1 (next to living room), bedroom #3 (isolation room), kitchen, bathroom #2 (hallway bathroom), garage converted into a second classroom with bathroom #1, computer/activity room (next to laundry room), backyard and front yard. The OFF LIMIT AREAS are bedroom #2 and laundry room (located in computer/activity room). Off limit areas are made inaccessible with child safety door handles. Licensee operates home as a Montessori program. LPA observed home to be clean and well ventilated. There were a variety of Montessori materials that were in good working condition. Home is equipped with furniture, toys and equipment that were observed to be age appropriate. Main classroom includes a fireplace that was made inaccessible to children and appropriately barricaded. Edges on fireplace and sharp edges in home were properly padded for additional safety. LPA observed cleaning supplies, poisons and other chemicals to be inaccessible behind child safety locked cabinets, closets, or located in an off limit area. LPA observed bathrooms to be in proper working condition, with appropriate sanitation products. Cabinets and drawers are made inaccessible to children with multiple child safety locks. Home is equipped with multiple emergency backpacks, first aid supplies, fire extinguisher, and a working smoke/carbon monoxide detector. (Continue 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: 03/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2023

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: KHO, MERIAM TUAZON	FACILITY NUMBER: 414001700
	VISIT DATE: 03/23/2023

NARRATIVE

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LPA observed both front yard and backyard to be entirely fenced and enclosed. Backyard is equipped with appropriate outdoor materials that were observed to be in good, working condition. Outdoor area includes age appropriate play structures that were observed to have resilient padding underneath. LPA did not observe any pools, spas or bodies of water on site. Water is made available to children indoors and outdoors with children's individual water bottles.

Home is equipped with a working phone on site. Phone number listed for licensee is current. Per licensee, there are no weapons or firearms in the home. Emergency drills are conducted monthly and are properly logged. Last emergency disaster drill was conducted 03/15/2023. LPA observed licensing documentation to be properly posted and made available for review.

LPA reviewed facility records that included 5 children files, licensee's and TA's files. All files were observed to be complete. Children's files have a record of emergency identification information as well as required immunizations. Both licensee and TA have a current CPR certification that will expire 07/2023. Both licensee and TA have a current Mandated Reporter certification that will expire 03/2024. Both licensee and TA have required immunizations that were made available for review.

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.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process

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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: 03/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2023

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: KHO, MERIAM TUAZON	FACILITY NUMBER: 414001700
	VISIT DATE: 03/23/2023

NARRATIVE

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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.

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.

No deficiencies were cited today under CCR, Title 22, Div. 12.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

An exit interview conducted and report was reviewed with the licensee, Meriam Kho.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2023

LIC809 (FAS) - (06/04)

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