414004224-12-15-2023-05-CC-JTSE-CYJPFF-20231215101639

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004224
Report Date: 12/15/2023
Date Signed: 12/15/2023 10:16:50 AM

Document Has Been Signed on 12/15/2023 10:16 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:	DEL BARCO, LILIANA		FACILITY NUMBER:	414004224
ADMINISTRATOR:	DEL BARCO, LILIANA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 315-8003
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94401
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 9	DATE:	12/15/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Licensee, Liliana Del Barco		TIME COMPLETED:	10:30 AM

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 12/15/2023, at approximately 8:45AM, Licensing Program Analyst (LPA) conducted an unannounced annual visit at the facility. LPA was granted entry to the facility by Licensee, Liliana Del Barco. LPA explained the purpose of the visit. Present during the visit was the Licensee, one helper (H1) and nine preschool age children. The facility is in compliance with capacity requirements on this day. The facility’s operating hours are from 8:00AM to 4:00PM. Extended care hours are offered as necessary from 4:00PM to 6:00PM. The facility operates as a Spanish Immersion Program. The facility is a single-level, two-bedroom, one-bathroom home. Daycare Areas: Classroom, Playroom, Bathroom, Patio, and Backyard. Off-limits Areas: Living Room, Bedroom #1, Bedroom #2, Kitchen, and Garage. LPA and Licensee inspected the home for any health and safety hazards. LPA observed the home to be in clean and orderly condition. The home is equipped with two 2A10BC fire extinguishers that are fully charged. There is a first aid kit present that is fully equipped. There is a combination smoke and carbon monoxide detector in the Classroom. LPA observed age-appropriate toys, equipment and learning materials to be present in the Classroom and Playroom. All electrical outlets are covered when not in use. There is a fireplace that is not located in the daycare areas. All cabinets and drawers in the Bathroom are secured by childproof locks. All off-limits areas are secured by childproof doorknobs or barriers. Per Licensee, there are no firearms located in the facility. LPA observed the Backyard to be clean and orderly, free of debris and other loose materials. Toys and equipment are stored in the Backyard until children are outside. The Backyard is enclosed by a fence that is at least five feet high. Continued on Page Two

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2023

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: DEL BARCO, LILIANA	FACILITY NUMBER: 414004224
	VISIT DATE: 12/15/2023

NARRATIVE

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LPA reviewed two personnel files and nine children’s files. Personnel files were observed to be complete, with immunization records available for review. Licensee’s First Aid/CPR training is current and expires in 5/2024. Licensee’s Mandated Reporter Training is current and expires in 5/2025.

Children’s files were observed to be complete, with all files containing Identification and Emergency (LIC700), Consent for Emergency Medical Treatment (LIC627), Notification of Parents’ Rights (LIC995A), Affidavit Regarding Liability Insurance (LIC282) and immunization records.

All required postings were observed to be posted in the Classroom and accessible for review. The facility conducts emergency drills every month. The facility last conducted an emergency drill on 12/14/23, and LPA observed that drills are properly documented and logged. The facility provides AM/PM snacks for children, and lunch for children who do not bring their own 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.

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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: DEL BARCO, LILIANA	FACILITY NUMBER: 414004224
	VISIT DATE: 12/15/2023

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.

No deficiencies were cited during today’s visit.
A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with the licensee, Liliana Del Barco.

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2023

LIC809 (FAS) - (06/04)

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