414002587-1-7-2025-05-CC-KKRN-DCQ2LP-20250107162953

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414002587
Report Date: 01/07/2025
Date Signed: 01/07/2025 04:30:19 PM

Document Has Been Signed on 01/07/2025 04:30 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:	NETANE, PAULINE H.		FACILITY NUMBER:	414002587
ADMINISTRATOR/ DIRECTOR:	NETANE, PAULINE H.		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 430-7536
CITY:	BELMONT	STATE: CA	ZIP CODE:	94002
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 3	CENSUS: 2	DATE:	01/07/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:50 PM
MET WITH:	Pauline Netane		TIME VISIT/ INSPECTION COMPLETED:	04:45 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 01/07/2025 at about 12:50pm, Licensing Program Analysts (LPAs) Katie Krenn and Jonathan Tse conducted an unannounced annual visit at the facility. LPAs met with Licensee, Pauline Netane and explained the purpose of the visit. Present during the visit was Licensee and two infants. The facility is in compliance with staffing and ratio requirements on this day. Daycare areas are: Living room, Dining room, Bedroom #1 & #2, Bathroom #1, and backyard. Off Limit areas are: Kitchen, Bedroom #3 (second level), and Garage. All off limit areas, including closets, are properly barricaded. LPAs and Licensee inspected the home for any health or safety hazards. There is a fully charged 2A10BC fire extinguisher present in the kitchen. There is an operational carbon monoxide detector and fire alarm present in the hall outside of the bedrooms. LPAs observed a fire alarm in the Living room. Off-limits areas are kept inaccessible to children in care with child proof mesh gates. LPAs observed that soaps were stored in the Bathroom cabinet that would be accessible for children using the Bathroom on their own. LPAs advised that poisons, cleaning detergents, and other chemicals be stored inaccessible to children in care. Licensee stated that they understood. LPAs observed there to be age-appropriate toys and learning materials present. Furniture is age-appropriate and free of rough or sharp edges. There is one crib and 2 pack n plays available for each infant in care. LPAs observed cribs to be in good repair, with mattresses equipped with tight-fitting sheets. LPAs observed the crib had a bumper, which the licensee removed. LPAs reviewed the safe sleeping regulation with the licensee and they stated that they understood. Bedding is provided by the facility. continued on page two

Daniel J Oquendo	TELEPHONE: (650) 266-8800
Katie Krenn	TELEPHONE: 650-266-8800
	DATE: 01/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025

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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Document Has Been Signed on 01/07/2025 04:30 PM - 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: NETANE, PAULINE H.	FACILITY NUMBER: 414002587
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/07/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above by not renewing the MRT by the expiration date, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/21/2025
	Plan of Correction
1 2 3 4	Licensee shall complete Mandated Reporter Training and maintain documentation in personnel file by set due date of 01/21/2024.

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.

Daniel J Oquendo	TELEPHONE: (650) 266-8800
Katie Krenn	TELEPHONE: 650-266-8800
	DATE: 01/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025

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: NETANE, PAULINE H.	FACILITY NUMBER: 414002587
	VISIT DATE: 01/07/2025

NARRATIVE

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LPAs observed a bouncing chair. Licensee stated that the parent of a former child had provided it. LPAs informed the Licensee that bouncers of any kind should not be used. The Licensee stated that she understood and she removed the chair from the children's area.

The facility is currently not providing snacks and lunch for children in care. Lunch and snacks are being provided from home.

LPAs observed that there were sufficient high chairs available for children in care, used only for feeding. Living room had age appropriate furniture and toys for children in care. The home was clean and free of debris.

LPAs observed the outdoor play area. There was a covered area with age appropriate toys and furniture. LPAs observed that mesh child proof gates were being used to keep the children off the stairs. In the uncovered outdoor play area, the LPAs observed that there were some propane tanks, motor oil, bicycles in disrepair, roofing materials, and window screens in an area that was accessible to children. LPAs discussed with Licensee moving those materials into an off-limits area. Licensee stated that they understood and would comply. In the outdoor play area LPAs observed age appropriate toys and play furniture in good repair.

While reviewing the files, LPAs observed a sheet for signing children in and out, a disaster plan, and a log for safety drills. The log showed that the last safety drill was done in November 2024. LPAs reminded Licensee that it is good to plan for how the safety drills would happen when the children are doing different activities such as napping or eating. Licensee stated that they understood.

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SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Katie Krenn	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025

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: NETANE, PAULINE H.	FACILITY NUMBER: 414002587
	VISIT DATE: 01/07/2025

NARRATIVE

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LPAs observed that two out of three children's files were complete. The Licensee stated that they might have the third file available online. Licensee contacted the child's parents to complete the file. LPAs observed that past sleep logs were not kept. Licensee said that the prior sleep logs had been discarded. LPAs observed that blank sleep logs were available for use. LPAs explained that the sleep logs needed to be kept for three years after the child leaves care.

LPAs observed that parents rights posted in a prominent place, the facility license was not posted. LPAs reminded Licensee that the license needs to be posted in a prominent place. Licensee stated that she understood and she posted it.

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.

continued on page four

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Katie Krenn	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025

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: NETANE, PAULINE H.	FACILITY NUMBER: 414002587
	VISIT DATE: 01/07/2025

NARRATIVE

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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-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.

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.

See LIC809-D for deficiency cited today regarding Mandated Reporter Training. See LIC9102-TV for technical violations issued today. Appeal rights were provided and explained to Licensee.

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

Exit interview conducted and report was reviewed with the licensee, Pauline Netane.

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Katie Krenn	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025

LIC809 (FAS) - (06/04)

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