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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004298
Report Date: 06/14/2024
Date Signed: 06/14/2024 11:32:55 AM


Document Has Been Signed on 06/14/2024 11:32 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:CABRERA CONTRERAS, EVELYN XIOMARAFACILITY NUMBER:
414004298
ADMINISTRATOR:CABRERA CONTRERAS, EVELYNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 250-6904
CITY:EAST PALO ALTOSTATE: CAZIP CODE:
94303
CAPACITY:14CENSUS: 8DATE:
06/14/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Licensee, Evelyn Xiomara Cabrera ContrerasTIME COMPLETED:
11:50 AM
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On June 14th, 2024, at approximately 8:35am Licensing Program Analyst (LPA) Tapia-Mandujano conducted an unannounced Annual and met with licensee, Evelyn Xiomara Cabrera Contreras. Upon arrival Licensee let LPA in through the front entrance of the facility. LPA disclose the purpose of the of the inspection. Present in the facility are Licensee and licensee's assistant supervising 8 children (2 infants, 5 preschoolers, and 1 School-age child). At this time the licensee is within capacity limits. All adults living and working at the facility are fingerprint cleared and associated.

Licensee rents home that consist of a 3 bedroom, 2 bathroom, single story house. Licensee lives in the home with Husband, 4 other adults, and 2 minor children. The hours of operation are Monday-Friday from 7:30am-5:30pm. Daycare areas are: Living Room, Bedroom #1, Bathroom #1, Dining area, portion of the back yard, and a portion of the front yard. Off limit areas are: Kitchen, Laundry area, Bedroom #2 and #3, Garage, Bathroom #2, and portion of the backyard. All off limit areas are properly barricaded.

LPA toured home for health and safety hazards. LPA observed the Day-care is clean, orderly with a variety of age-appropriate toys for children. The home has age-appropriate equipment available for children in care. All furniture inspected is in good repair. Home has a fireplace that is properly barricaded. Licensee does not have any pets. The home has no pools or bodies of water in the home. LPA reminded licensee of water safety hazards. Licensee was reminded that baby walkers, bouncers, jumpers and any other similar items are to not be used for children in care. LPA observed infant children to sleep in pack and play in Bedroom #1. LPA observed pack and play to be free of loose of objects and/or articles. LPA observed licensee is maintaining the safe sleep logs.


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SUPERVISOR'S NAME: Marie RodriguezTELEPHONE: (650) 732-0619
LICENSING EVALUATOR NAME: Leslit Tapia-MandujanoTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 06/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/14/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 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: CABRERA CONTRERAS, EVELYN XIOMARA
FACILITY NUMBER: 414004298
VISIT DATE: 06/14/2024
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Licensee has a fully stocked First Aid kit and was reminded to be aware of the expiration dates. There was multiple fully charged fire extinguishers, smoke alarms, and carbon monoxide alarms that are in working order. Per licensee, phone number listed for Licensee is current. Per Licensee, there are no weapons or firearms in the home.

LPA reviewed eight children’s records which were complete. Licensees Mandated reporter training expires on 10/2025 and Pediatric CPR/First Aid certification expires on 06/2025. Licensee's last emergency drill was conducted 12/17/23. LPA reminded that licensee she must conduct an emergency drill by 6/17/24. Emergency drills must be conducted at least every 6 months and be properly logged. All the required posting documentation, such as the facility license, Notification of Parental Rights and have been placed in a prominent area for parents or representatives to review.

This facility provides Incident Medical Services- IMS. At this moment, licensee does not have any children enrolled. LPA reminded licensee to maintain the storage of medication and equipment/supplies, and if we will review children's, personnel, and administrative records when children are enrolled. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA information Line at (800) 514-0301 (voice) or (800) 514-0383 TTY) and line to publication. Commonly Asked Questions about Child Care Centers and ADA are available at: https://www.ada.gov/resources/child-care-centers/.

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 atwww.cdss.ca.gov/inforesources/community-care-licensing/inspection-process



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SUPERVISOR'S NAME: Marie RodriguezTELEPHONE: (650) 732-0619
LICENSING EVALUATOR NAME: Leslit Tapia-MandujanoTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2024
LIC809 (FAS) - (06/04)
Page: 3 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: CABRERA CONTRERAS, EVELYN XIOMARA
FACILITY NUMBER: 414004298
VISIT DATE: 06/14/2024
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Licensee was reminded that all adults 18 and over, 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 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-and-resources/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.

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, Evelyn Xiomara Cabrebra Contreras, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS on 06/14/24.

No deficiencies were cited today under CCR, Title 22, Div. 12, Chapt. 1.



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

Exit interview conducted and report was reviewed and report was translated in Spanish by LPA Tapia-Mandujano to the licensee, Evelyn Xiomara Cabrebra Contreras.
SUPERVISOR'S NAME: Marie RodriguezTELEPHONE: (650) 732-0619
LICENSING EVALUATOR NAME: Leslit Tapia-MandujanoTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2024
LIC809 (FAS) - (06/04)
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