414004462-5-4-2022-05-CC-BVAN-CE4UJS-20220504153800

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004462
Report Date: 05/04/2022
Date Signed: 05/04/2022 03:38:35 PM

Document Has Been Signed on 05/04/2022 03:38 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	PORTILLO, JESSICA J.		FACILITY NUMBER:	414004462
ADMINISTRATOR:	PORTILLO, JESSICA J.		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 766-6443
CITY:	BURLINGAME	STATE: CA	ZIP CODE:	94010
CAPACITY:	14	CENSUS: 9	DATE:	05/04/2022
TYPE OF VISIT:	POC	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Jessica Portillo		TIME COMPLETED:	03:45 PM

NARRATIVE

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On May 4, 2022, Licensing Program Analyst (LPA) Van met with the Licensee, Jessica Portillo, for an unannounced inspection of the Plan of Correction (POC). The purpose of the inspection was explained and was granted entry to the home of the Licensee. There are nine children in care with the Licensee and a helper today. All staff present have criminal record clearance on file.

On April 27, 2022, during the required annual inspection, the following deficiencies were cited:

Section 102417(b)(1) The children's records review confirmed that the Licensee did not comply with the Licensed limitation requirement, in that 6 out of 11 children in care were infants. In today's inspection. The Licensee provided schedules of all infants currently enrolled at the daycare. Per Licensee, not all children are enrolled full time. Licensee ensures that part-time infants' schedules are not overlapping to reduce the risk of operating out of infant limitation.

Section 102370(d)(1) The staff records review confirmed that Licensee's helper (S1) did not have criminal record clearance prior to working at the daycare. The Licensee stated that S1 is working with Guardian to acquire an exemption and said that until S1 is cleared, Licensee will not be allowed S1 to be at the daycare until the exemption process is approved. During the visit, LPA did not observe S1 at the daycare.

Section 102417(g)(9)(A)(1); Licensee did not document or keep a record of the fire and earthquake drill. Today, the Licensee showed proof of a log with the proper date and time of the fire and earthquake log. Section 102417(g)(9)(A)(1) deficiency is cleared.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2022

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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: PORTILLO, JESSICA J.	FACILITY NUMBER: 414004462
	VISIT DATE: 05/04/2022

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All deficiencies cited on April 27, 2022, cleared today, May 4, 2022.

An exit interview was conducted with the Licensee, and a consultation was provided. In today's inspection, no deficiencies were observed. The Licensee, Jessica Portillo, signed the report. Today's report, May 4, 2022, a notice of site visit, and a copy of the Letter of Deficiencies Citations will be sent to the Licensee email by the close of business on May 4, 2022. Confirmation of receipt is required. LPA instructed the Director that the site visit notice had to be posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2022

LIC809 (FAS) - (06/04)

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