414004484-12-12-2023-05-CC-JTSE-CYFTH7-20231212134415

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004484
Report Date: 12/12/2023
Date Signed: 12/12/2023 01:44:25 PM

Document Has Been Signed on 12/12/2023 01:44 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:	RODRIGUES, MICHAEL		FACILITY NUMBER:	414004484
ADMINISTRATOR:	RODRIGUES, MICHAEL		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 245-7819
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94403
CAPACITY:	14	CENSUS: 9	DATE:	12/12/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	11:50 AM
MET WITH:	Licensee, Michael Rodrigues		TIME COMPLETED:	02:00 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 12/12/2023, at approximately 11:50AM, Licensing Program Analyst (LPA) Jonathan Tse conducted an unannounced annual visit at the facility. LPA was granted entry to the facility by Licensee, Michael Rodrigues. LPA explained the purpose of the visit. Present in the facility was the Licensee, Licensee’s spouse, two helpers, three infants, five preschool age children, and one school-age child. The facility is in compliance with capacity requirements on this day. All adults working or living in the home have acquired fingerprint clearance and are associated to the facility. The facility’s operating hours are from Monday to Friday, 8AM to 5PM. The facility is a single-level three-bedroom, two-bathroom home. Daycare Areas: Living Room, Dining Room, Kitchen, Bedroom #2 (used as a napping/play room), Bathroom #1, Bathroom #2, and Backyard. Off-limits Areas: Bedroom #1, Bedroom #3 and Front Yard. LPA and Licensee inspected the home for any health and safety hazards. The home was observed to be in clean and orderly condition. There is a fireplace present in the Living Room that is secured by a childproof cover and is additionally blocked by a couch to be inaccessible to children. There is a 2A10BC fire extinguisher present. There are two combination smoke and carbon monoxide detectors present in the Living Room. There are smoke and carbon monoxide detectors present in Bedroom #2. There are first aid kits stored in the Kitchen and Bedroom #2 that were observed to be properly equipped. All Kitchen and bathroom cabinets and drawers are secured as necessary with childproof locks. LPA observed bathroom counters to only have handwashing soap present. Off-limits areas are properly secured with childproof doorknobs. Bedroom #2 is used as a napping/play room and is equipped with cots, cribs, and mats for children to use. The facility provides sheets and washes them once a week. Bedding is provided by the families of children in care. Continued on Page Two

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Jonathan Tse	TELEPHONE: (650) 464-4927
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023

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: RODRIGUES, MICHAEL	FACILITY NUMBER: 414004484
	VISIT DATE: 12/12/2023

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
26
27
28
29
30
31
32

Page Two
The Backyard is currently not in use due to work being done on the exterior of the home. LPA observed there to be sufficient cushioning in the form of artificial turf. There are age-appropriate toys and equipment available for use. The Backyard is enclosed by a fence that is at least five feet high. There is a storage shed present that is kept locked. Per Licensee, the Backyard is checked for debris and loose materials daily. There are no pools of other bodies of water in the facility.

LPA reviewed four personnel files and nine children’s files. All personnel files were observed to be complete. First Aid/CPR certifications expire on 8/2024. Mandated Reporter Training expires on 7/2024. All children’s files were observed to be complete.

All required postings are available for review upon entry to the facility. Children bring their own lunches to the facility and the facility provides AM/PM snacks. The facility uses the Brightwheel app to communicate with parents. There is a pet dog located in the facility, but children do not have contact with the dog during operating hours.

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.

Continued on Page Three

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Jonathan Tse	TELEPHONE: (650) 464-4927
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023

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: RODRIGUES, MICHAEL	FACILITY NUMBER: 414004484
	VISIT DATE: 12/12/2023

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
26
27
28
29
30
31
32

Page Three
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, Michael Rodrigues.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Jonathan Tse	TELEPHONE: (650) 464-4927
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023

LIC809 (FAS) - (06/04)

Page: 3 of 3