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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004153
Report Date: 07/13/2023
Date Signed: 07/13/2023 09:03:10 AM


Document Has Been Signed on 07/13/2023 09:03 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:ROSALES, ROSALVAFACILITY NUMBER:
414004153
ADMINISTRATOR:ROSALES, ROSALVAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 787-5736
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94061
CAPACITY:14CENSUS: DATE:
07/13/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:10 AM
MET WITH:Rosalva RosalesTIME COMPLETED:
09:20 AM
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On July 13, 2023, at 08:10 AM, Licensing Program Analyst (LPA) Maria Olguin-Leon, conducted an unannounced, plan of correction (POC) visit. LPA met with Licensee, Rosalva Rosales and explained the purpose of the visit. Present during today’s visit are Licensee, 1 helper and 7 enrolled children (2 infants and 5 preschoolers).

On June 27, 2023, LPA Olguin-Leon met with licensee to conduct an unannounced, annual inspection visit. During annual visit, LPA observed an unfingerprinted adult working with the children in care. LPA issued a Type A citation for unfingerprinted adult. A POC was developed with licensee. Facility was cited a type B for not completing CPR/First Training, which poses a potential health, safety, or personal rights risk to persons in care.

As of this date, LPA observed unfingerprinted adult is not present at facility. Unfingerprinted adult is no longer working at facility. Licensee stated unfingerprinted adult is in process of obtaining an ID and fingerprint clearance.

During today's visit, LPA observed signed and completed Acknowledgement of Receipt of Licensing Reports (LIC9224) for 7 of the 10 enrolled children. The other 3 children have been on vacation. Licensee will collect LIC9224 once children return. LPA observed certificate of completion for CPR/First Aid training dated 07/01/2023, POC has been cleared as of today.

Deficiencies cited on June 27, 2023, have been cleared as of this date. LPA provided licensee copy of POC report. No deficiencies were cited today.

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.

Exit interview conducted and report was reviewed with Licensee, Rosalva Rosales.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Maria Olguin-LeonTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 07/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/13/2023
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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