414002472-12-21-2023-05-CC-JTSE-CYQSMF-20231221125953

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414002472
Report Date: 12/21/2023
Date Signed: 12/21/2023 01:00:07 PM

Document Has Been Signed on 12/21/2023 01:00 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	GUNION, MARY D.		FACILITY NUMBER:	414002472
ADMINISTRATOR:	GUNION, MARY D.		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 345-0658
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94403
CAPACITY:	14	CENSUS: 7	DATE:	12/21/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	10:55 AM
MET WITH:	Licensee, Mary Gunion		TIME COMPLETED:	01:15 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	On 12/21/2023, at approximately 10:55AM, Licensing Program Analyst (LPA) Jonathan Tse conducted an unannounced annual visit at the facility. LPA was granted entry to the facility by Licensee, Mary Gunion. LPA explained the purpose of the visit. Present during the visit were the Licensee, Licensee’s helper (H1), four infants and three preschool age children. The facility is in compliance with capacity requirements on this day. The facility’s operating hours are from 8:00AM to 5:00PM. Daycare Areas: Living Room #2, Dining Area, Kitchen, Bathroom #1 (located in living room #2), Bathroom #2, Bedrooms #1 and #2 (napping rooms only), Bedroom #3 (circle time room), and Backyard. Off-limits Areas: Living Room #1 (pass by only), Bedroom #4, Bathroom #3 (located in Master Bedroom). LPA inspected the home for any health and safety hazards. LPA observed the home to be in clean and orderly condition. There are age-appropriate toys and learning materials present in Living Room #2 and Bedroom #3. LPA observed there to be operational smoke and carbon monoxide detectors present in the home. There is a fully charged 2A10BC fire extinguisher stored in the Kitchen. Kitchen cabinets that are used to store cleaning agents or other chemicals are secured with childproof locks. LPA observed the first aid kit to be complete and fully stocked. There is a fireplace in an off-limits area, Living Room #1, that is secured by a gate to be inaccessible to children in care. Per Licensee, there are no firearms present in the home. The Backyard is enclosed by a fence that is at least five feet high. There are age-appropriate toys, equipment and play structures present in the Backyard. There is sufficient cushioning for children in the form of grass or woodchips. There are no pools or other bodies of water present in the facility. Continued on Page Two

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Jonathan Tse	TELEPHONE: (650) 464-4927
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023

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: GUNION, MARY D.	FACILITY NUMBER: 414002472
	VISIT DATE: 12/21/2023

NARRATIVE

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LPA reviewed two personnel files and seven children’s files. All children’s files were observed to be complete. All infants have sleep logs available for review. Licensee’s First Aid/CPR training expires 6/2024. Licensee’s Mandated Reporter Training expires 5/2024. LPA discussed the requirement to have Mandated Reporter Training completed for all adults working with children in the facility.

LPA observed all required postings to be visible and accessible in the Kitchen. The facility last conducted an emergency drill on 9/14/2023. All drills are properly documented and logged. The facility is nut-free.The facility provides snacks for children, and children bring lunch from home. Infants’ food and milk is brought from home.

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.

Licensee 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.

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-andresources/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.

Continued on Page Three

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Jonathan Tse	TELEPHONE: (650) 464-4927
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: GUNION, MARY D.	FACILITY NUMBER: 414002472
	VISIT DATE: 12/21/2023

NARRATIVE

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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/.

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, Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.
No deficiencies were cited during today’s visit.
See LIC9102-TA for Technical Assistance provided today.
A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Mary Gunion.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Jonathan Tse	TELEPHONE: (650) 464-4927
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023

LIC809 (FAS) - (06/04)

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