214005345-9-9-2024-05-CC-HLEG-D8XRAY-20240909125156

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 214005345
Report Date: 09/09/2024
Date Signed: 09/09/2024 12:52:03 PM

Document Has Been Signed on 09/09/2024 12:52 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	MC COY, KIYOKO		FACILITY NUMBER:	214005345
ADMINISTRATOR:	MC COY, KIYOKO		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 342-9482
CITY:	SAN RAFAEL	STATE: CA	ZIP CODE:	94903
CAPACITY:	14	CENSUS: 8	DATE:	09/09/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:49 AM
MET WITH:	Kiyoko McCoy		TIME COMPLETED:	01:00 PM

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On 9/9/2024, Licensing Program Analyst (LPA) Hanson Leong conducted an unannounced annual visit and met with the Licensee, Kiyoko McCoy. LPA explained the purpose of the visit to the licensee.

Eight pre-k children and three adults (the licensee, the licensee’s husband, and the licensee’s assistant) were present during the visit. The three adults received criminal record clearance from the department. The licensee holds a large license and is within capacity limits and ratios for today’s visit.

LPA observed that all required documents, such as the facility license, the Notification of Parental Rights, and the Earthquake Preparedness Checklist, were displayed in a prominent, publicly accessible location.

The most recent emergency disaster drill was conducted on 1/31/2024, and the LPA observed that it was properly documented. LPA reviewed the emergency disaster drill log and found that it was not conducted every six months. LPA reminded the licensee to complete and properly record them every six months.

Day-care Areas: Front patio, Living Room, Bathroom #1, and Backyard.

Off-Limit Areas: Bedroom #1, Bedroom #2, Bedroom #3, Bathroom #2, Garage, and Gated Path (pass-through only). The licensee understands that off-limits areas may not be used for childcare during business hours.

LPA conducted inspections of the indoor and outdoor daycare areas to identify health and safety hazards. A fire extinguisher, a first aid kit, and multiple carbon monoxide and smoke detectors are present in the home. LPA found the home's interior clean and orderly, with proper heating and ventilation for safety and comfort. Disinfectants, cleaning solutions, poisons, and other hazardous items were stored in areas inaccessible to children. The bathroom was found to be clean and fully operational. The toilet and handwashing facility were well-kept, safe, and clean. The bathroom is equipped with appropriate toileting equipment and appropriate sanitation products.

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SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson Leong	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2024

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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: MC COY, KIYOKO	FACILITY NUMBER: 214005345
	VISIT DATE: 09/09/2024

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LPA observed that the daycare areas had age-appropriate toys, furniture, and educational materials. The home had permanent or portable storage space for the children’s clothing and personal belongings. Electrical outlets were properly covered with child safety covers. According to the licensee, no firearms or weapons are on the premises.

The backyard is enclosed by a fence and equipped with outdoor play equipment that is in good condition. The areas around and under high climbing equipment, swings, slides, and similar equipment were observed to be cushioned with grass. LPA observed a fish tank in the home, which was inaccessible to the children.

The licensee does not currently provide food service for the children. The children's parents or guardians must provide lunches and snacks for their children. Per the licensee, one child enrolled currently has an allergy. The child’s medication was observed locked in a cabinet and inaccessible to the children.

Sleeping mats are available for the children to rest or take a nap. According to the licensee, most children do not sleep because she ends her program at 2 pm.

LPA reviewed five children’s files and confirmed that four children have complete files that include their emergency contact information and medical information. One child's immunization record was missing. LPA reminded the licensee that each child must have their immunization records in their file.

LPA reviewed the two staff files and confirmed that all required forms were present. LPA found that the licensee possesses a current Pediatric First Aid/CPR certification, which expires on 10/2025.

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.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. 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 link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-carecenters/.

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SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson Leong	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2024

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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: MC COY, KIYOKO	FACILITY NUMBER: 214005345
	VISIT DATE: 09/09/2024

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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.

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

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.

No deficiencies were issued today during LPA's visit.

A copy of today's report was given to the licensee.

A Notice of Site Visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Licensee, Kiyoko McCoy.

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson Leong	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2024

LIC809 (FAS) - (06/04)

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