414004252-11-27-2023-05-CC-MTSO-CXZ2ZL-20231127165032

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004252
Report Date: 11/27/2023
Date Signed: 11/27/2023 04:50:52 PM

Document Has Been Signed on 11/27/2023 04:50 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:	NADELMAN, AMINTA & FANNY		FACILITY NUMBER:	414004252
ADMINISTRATOR:	NADELMAN, AMINTA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 892-8214
CITY:	PACIFICA	STATE: CA	ZIP CODE:	94044
CAPACITY:	14	CENSUS: 8	DATE:	11/27/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	01:18 PM
MET WITH:	Aminta Nadelman		TIME COMPLETED:	05:00 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 November 27, 2023, Licensing Program Analyst (LPA) Tso conducted an unannounced, annual visit to the Family Child Care Home listed above. The LPA was granted entry by the Licensees, Aminta Nadelman. LPA explained the purpose of the visit. Present during LPA's visit included licensee, licensee's spouse, licensee's son, and daughter-in-law (another licensee), and 8 enrolled children (3 infants and 5 preschool age). Licensee is operating within capacity limits and ratio during LPA's visit. Licensee lives in a 3-bedroom multi-level home, with spouse and daughter-in-law. All adults living in the home have fingerprint clearance on file. The hours of operation are Monday through Friday 8:00am to 5:00pm. The DAY CARE AREAS are on the Lower level Family Room, Bathroom 2, Bedroom 3, and back yard. The rest of the home is off-limits. The off-limits areas are properly barricaded with child safety gates and/or closed doors. There are stairs in the backyard to upper stairs that were observed to be barricaded. The LPA and the licensee both performed careful inspections of the daycare facility to look for any potential health and safety hazards. Toys and equipment that are suitable for children of the proper age range are provided at the daycare. The building has sufficient lighting and ventilation, and it is free of any defects or conditions that put children at risk. The facility is equipped with a first aid kit that is completely loaded with everything that is required for the treatment of injuries. The daycare facility is equipped with a combined smoke and carbon monoxide detector, and a fire extinguisher that is always ready for use. Every garbage can and power outlet has been covered. Products for cleaning and washing, detergents, and any other materials that could put children in danger are stored out of the children’s reach. The LPA did not find any walkers, bouncers, or other comparable objects during today’s inspection. (Continue Report on Page 2...)

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Man Tso	TELEPHONE: (650) 379-9021
LICENSING EVALUATOR SIGNATURE:	DATE: 11/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/27/2023

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: NADELMAN, AMINTA & FANNY	FACILITY NUMBER: 414004252
	VISIT DATE: 11/27/2023

NARRATIVE

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LPA observed that 2 cribs with covers, 1 crib with blanket on crib edge. The licensee removed them immediately. LPA also observed that an infant wears a sleep sack. LPA discussed with the licensee that sleep sack is not allowed. (Please refer to LIC809D). Apart from that, LPAs did not observe any hazardous materials to be accessible to children. According to the licensee, there are reportedly no firearms or other weapons on the premises. The LPA observed that the facility did not have any bodies of water.

The LPA observed that the facility had posted all the required forms, including the facility license, Notification of Parental Rights, Earthquake Preparedness Checklist, and Notification of Personal Rights. The Licensee is aware that smoking is not permitted in a family childcare facility.

Bathroom for children's use was observed to be in proper working condition. LPA did not observe any hazardous materials to be accessible to children. The entire backyard is fully enclosed and fenced. The outdoor area is equipped with a variety of toys and materials. There is a play structure in the backyard that was observed to be in good condition. Flooring in backyard was observed to be clean.

LPA reviewed six children’s records. Children’s files have a record of emergency identification information on file. Licensee's Pediatric First Aid/CPR is current and will expire 06/2024. Emergency drills are properly logged and maintained. Last emergency drill was conducted 09/15/2023. Licensee has licensing documentation properly posted and available for review. However, the15-minute check record for an infant was up to 04/2023 only. LPA discussed with the licensee that the 15-minute check and records should be applicable to all infants (age below 24 months) (Please refer to LIC809D).

LPA reminded licensee about Mandated Reporter training available www.mandatedreporterca.com. Licensee was reminded Mandated Reporter training must be renewed every 2 years and all staff whom directly work with children must complete training. But Aminta Nadelman’s mandated reporter training certificate expired on 08/05/2020. LPA reminded the licensee to complete the training.
(Continue Report on Page 3...)

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Man Tso	TELEPHONE: (650) 379-9021
LICENSING EVALUATOR SIGNATURE:	DATE: 11/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/27/2023

LIC809 (FAS) - (06/04)

Page: 2 of 5

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: NADELMAN, AMINTA & FANNY	FACILITY NUMBER: 414004252
	VISIT DATE: 11/27/2023

NARRATIVE

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Licensee was reminded, as of September 1, 2016, all Staff and Volunteers must provide proof of immunization against pertussis, measles, and influenza, or qualifies for an exemption, pursuant to Health and Safety code 1596.7995 and 1597.622.

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.

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, the licensee, Aminta Nadelman, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Please refer to LIC 809D for today’s citation. A copy of today’s report and the facility’s appeal rights were given to Aminta Nadelman. The Notice of Site Visit was given to Aminta Nadelman and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Exit interview conducted and report was reviewed with Aminta Nadelman.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Man Tso	TELEPHONE: (650) 379-9021
LICENSING EVALUATOR SIGNATURE:	DATE: 11/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/27/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 11/27/2023 04:50 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: NADELMAN, AMINTA & FANNY	FACILITY NUMBER: 414004252
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/27/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(f)

An infant shall not be swaddled while in care. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA obsevation, there is an infant wears sleep sack, the licensee did not comply with the section cited above in. which poses a potential health and safety risk to persons in care.
	POC Due Date: 12/15/2023
	Plan of Correction
1 2 3 4	The licensee should inform the parents and with a note signed by the parent to acknowlege not let the child wear sleep sack. The parent signed note should be sent to licensing by the due date stayed above.

Type B

Section Cited

CCR

102425(j)(2)(D)(c)

Time of each 15-minute check. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, and record review, the licensee did not comply with the section cited above in 1 infant's record only up to 04/2023 which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/15/2023
	Plan of Correction
1 2 3 4	Licensee must ensure that the 15-minute check must be documented with initial. The Licensee agrees to move forward to document the sleep checks for all infants under 24 months and submit the documents to LPA by December 15, 2023.

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: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Man Tso	TELEPHONE: (650) 379-9021
LICENSING EVALUATOR SIGNATURE:	DATE: 11/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/27/2023

LIC809 (FAS) - (06/04)

Page: 4 of 5

Document Has Been Signed on 11/27/2023 04:50 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: NADELMAN, AMINTA & FANNY	FACILITY NUMBER: 414004252
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/27/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(b)

(b) Cribs or play yards shall be free from all loose articles and objects. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation that 2 cribs with covers, 1 crib with blanket on crib edge. The licensee removed them immediately. The licensee did not comply with the section cited above in, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/28/2023
	Plan of Correction
1 2 3 4	The licensee should remove all loose items on the cribs, take the pictures and send the pictures to the Licensing by the due date stated above.

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.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Man Tso	TELEPHONE: (650) 379-9021
LICENSING EVALUATOR SIGNATURE:	DATE: 11/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/27/2023

LIC809 (FAS) - (06/04)

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