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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002538
Report Date: 07/17/2024
Date Signed: 07/17/2024 11:07:54 AM

Document Has Been Signed on 07/17/2024 11:07 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:KERSEG, SARAH E.FACILITY NUMBER:
414002538
ADMINISTRATOR/
DIRECTOR:		KERSEG, SARAH E.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 341-9716
CITY:FOSTER CITYSTATE: CAZIP CODE:
94404
CAPACITY: 14TOTAL ENROLLED CHILDREN: 13CENSUS: 10DATE:
07/17/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:44 AM
MET WITH:Sarah KersegTIME VISIT/
INSPECTION COMPLETED:
11:25 AM
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On July 17, 2024, at approximately 8:45am, Licensing Program Analyst (LPA) Maria Olguin-Leon conducted an unannounced annual inspection and met with licensee Sarah Kerseg, and purpose of inspection was explained. Present during today’s visit was Licensee, 2 teenage volunteers and 10 preschool age children. Licensee is operating within capacity and ratio requirements on this day. Facility hours of operation are Monday - Friday from 8:30pm to 3:30pm.

LPA and Licensee toured the home for health and safety hazards. Home is a tri-level story home. Day Care Areas: Lower room (main classroom), dress up room, bathroom, front yard and backyard located behind main classroom. Off Limits Areas: Entire second & third floor, garage, and backyard with swimming pool. Isolation area for ill children will be in dress up room and away from other children. Parents enter home through side gate located on right side of home. LPA observed home to be clean and orderly. Home is well light and has proper ventilation. LPA observed electrical outlets are barricaded with furniture. Steps leading to 2nd floor is properly barricaded with a childproof retractable gate. Chimney is properly barricaded with a storage cabinet. Cleaning supplies and other potentially harmful items are stored inaccessible to children. There are plenty of age-appropriate toys, books, child size furnishings, learning material and a loft all in good condition. There is a fish tank located in main classroom. Front yard is surrounded with a 4 ft gate and equipped with toys and grass to cushion falls. Backyard patio is equipped with cement and plenty of age-appropriate toys which includes playhouses, ride on toys, and child size furniture. Backyard is surrounded with a 5 ft. fence. LPA observed a swimming pool on the left side of backyard which is barricaded with a cement wall and gate is equipped with a number code key lock.

Home is equipped with a working dual carbon monoxide/smoke detector and a fully charged fire extinguisher, which was serviced on 04/2023. LPA reviewed first aid kit and kit is fully stocked. Licensee has a landline and uses a cell on the premises. Per licensee, there are no weapons or firearms in the home. Children do not nap at the facility.

Cont. page 2…
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE: DATE: 07/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/17/2024
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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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: KERSEG, SARAH E.
FACILITY NUMBER: 414002538
VISIT DATE: 07/17/2024
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LPA reviewed 5 children’s files. LPA reminded Licensee to maintain files for volunteers. Per Licensee, liability insurance carrier is DCI. Licensee maintains an updated Children’s roster. Licensee CPR/First Aid has expired. Licensee Mandated Reporter training has expired recently. Children bring their own meals from home. LPA observed Childcare License, Emergency Disaster Plan (LIC610A) and Parent's rights posted. Last emergency drill was conducted on May 15, 2024, and is properly documented.

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.

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/.

The Licensee was reminded about the Provider Information Notices (PINs) on the CCLD website. Licensee was 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's reviewed AB 1207 with the Licensee.

As of January 1, 2018, all staff must complete Mandated Reporter Training every two years. LPA reminded licensee about Mandated Reporter training available www.mandatedreporterca.com

Cont. page 3...
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2024
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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: KERSEG, SARAH E.
FACILITY NUMBER: 414002538
VISIT DATE: 07/17/2024
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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. LPAs also informed licensees 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.

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 informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the LICENSEE, Sarah Kerseg confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.



See page LIC809D for deficiency being cited today, in accordance with the California Code of Regulations, Title 22. Appeal Rights were provided.

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

Exit interview conducted and report was reviewed with the licensee, Sarah Kerseg.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/17/2024 11:07 AM - It Cannot Be Edited


Created By: Maria Olguin-Leon On 07/17/2024 at 10:37 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: KERSEG, SARAH E.
FACILITY NUMBER: 414002538

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/17/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, licensee did not comply with the section cited above as licensee's CPR & First Aid Certification has expired, which poses a potential health, safety or personal rights risk to persons in care.


Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/31/2024
Plan of Correction
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Licensee will send proof of enrollment of the training or completed training to LPA Olguin-Leon by the POC date.
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 Rodriguez
LICENSING EVALUATOR NAME:Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:
DATE: 07/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/17/2024


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