414002268-11-2-2022-05-CC-BVAN-CKSQJ8-20221102121218

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414002268
Report Date: 11/02/2022
Date Signed: 11/02/2022 12:12:34 PM

Document Has Been Signed on 11/02/2022 12:12 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	SCULLY, ELIZABETH A.		FACILITY NUMBER:	414002268
ADMINISTRATOR:	SCULLY, ELIZABETH A.		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 766-0869
CITY:	BURLINGAME	STATE: CA	ZIP CODE:	94010
CAPACITY:	14	CENSUS: 7	DATE:	11/02/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Elizabeth Scully		TIME COMPLETED:	12:30 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	Licensing Program Analyst (LPA) Van performed an annual 1-year mandatory inspection, which included checking the interior and exterior of the facility and discussing the required childcare paperwork with the Licensee. Licensee Elizabeth Scully and two helpers supervised seven children today. Every adult living or working in the house has a criminal record clearance. Hours of operation currently are Monday-Friday from 8:30 am to 12:30 pm. Day Care Areas are the entire first floor, garage, and backyard. The Off-Limits Areas are on the second floor level of the home. During the inspection, the Licensee requested to remove the living room, dining, kitchen, and sunroom on the first floor previously licensed daycare to off-limit areas. LPA informed the Licensee a new facility sketch is required to complete the request. All off-limit locations have appropriately been gated. The Licensee has valid childcare liability insurance on file. LPA inspected the facility's indoor and outdoor areas for health and safety hazards. The childcare area is clean and organized, with age-appropriate toys and equipment. The Licensee acknowledges that no baby walkers, bouncers, exersaucers, or other similar items are permissible to be used during daycare hours. The house has sufficient lighting and ventilation. A functional telephone, multiple working smokes, carbon monoxide detectors, and a fully charged 2A10BC fire extinguisher are all in the house. According to the Licensee, there are no bodies of water on the premises. Daycare children have no access to detergents, disinfectants, or cleaning chemicals. Per Licensee, there are no guns or weapons in the house. The Licensee stated she has three cats, resides in off-limit areas, and has up-to-date vaccinations. The backyard is completely fenced. The outdoor play structures and toys are age-appropriate, in good condition, and clear of loose parts or hazards. Continued on page 2...

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 11/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022

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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SCULLY, ELIZABETH A.	FACILITY NUMBER: 414002268
	VISIT DATE: 11/02/2022

NARRATIVE

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The Licensee and helpers have valid CPR and First Aid certifications and up-to-date Mandated Reporter Training on file. Emergency drills are held at least once every six months, and each drill is appropriately logged/documented by the Licensee. All children's medications are stored appropriately. LPA reminded the Licensee to check the medications for expiration occasionally. The discipline used is redirection. The children's roster has been reviewed and found to be complete and up to date. Children's files were reviewed. The Licensee maintains thorough records for all children in their care, including vaccination records and Parental Rights forms. LPA noted that each kid had a complete emergency information card that included the child's full name, phone number, and the location of a parent or authorized person who may be called in an emergency. There is no transportation provided. Capacity options were reviewed, 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. All mandatory postings are posted (License/Parent's Rights poster/Emergency Disaster Plan and Earthquake Preparedness Checklist).

During the inspection, LPA requested the following documents from the Licensee to be sent to the Licensing office to complete the annual inspection.
-Updated LIC 610A
-Updated Facility Sketch LIC 999A to reflect the new off-limit areas
-Incidental Medical Services (IMS) Plan

LPA discussed the safe sleep regulations with the Licensees 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. 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 registering all infant devices with the CPSC to be notified of any recalls on their purchased equipment. Continued on page 3.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 11/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022

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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SCULLY, ELIZABETH A.	FACILITY NUMBER: 414002268
	VISIT DATE: 11/02/2022

NARRATIVE

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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.
The 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.
The Licensee was reminded about the Provider Information Notices (PINs) on the CCLD website. Licensees were 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. LPA 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. Effective July 1, 2020, Licensees must have proof of completion of EMSA certified lead poison training if applying for a change of location or capacity change to an existing license.

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SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 11/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022

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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SCULLY, ELIZABETH A.	FACILITY NUMBER: 414002268
	VISIT DATE: 11/02/2022

NARRATIVE

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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.
During today's inspection, no deficiencies were discovered. Licensee Elizabeth Scully read and signed the report. Today's report and site visit notice were provided to the Licensee. LPA informed the Licensee that a site visit notification must be posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 11/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022

LIC809 (FAS) - (06/04)

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