214005398-3-13-2023-05-CC-HLEG-CPVQ8G-20230313115642

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 214005398
Report Date: 03/13/2023
Date Signed: 03/13/2023 11:56:51 AM

Document Has Been Signed on 03/13/2023 11:56 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	ALVAREZ, ALCIRA		FACILITY NUMBER:	214005398
ADMINISTRATOR:	ALVAREZ, ALCIRA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 728-5449
CITY:	SAN RAFAEL	STATE: CA	ZIP CODE:	94903
CAPACITY: 10	TOTAL ENROLLED CHILDREN: 9	CENSUS: 7	DATE:	03/13/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:41 AM
MET WITH:	Alcira Alvarez		TIME COMPLETED:	12:10 PM

NARRATIVE

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On 3/13/2023, Licensing Program Analyst (LPA), Hanson Leong, made an unannounced annual visit to the Alcira Alvarez’s day-care facility. The LPA was granted entry by the Licensee, Alcira Alvarez. The LPA explained the purpose of the visit to the licensee. All the individuals listed on the facility’s roster have been granted permission to work or be present in a childcare facility. The LPA observed the licensee and her assistant supervising four infants, two preschool age children and the licensee's daughter. Children's capacity and ratio requirements were observed to be in compliance.

The LPA and the licensee both performed careful inspections of the day-care facilities 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 day-care. The building has sufficient lighting and ventilation, and it is free of any defects or conditions that could put the children in its care in 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 day-care facility is equipped with a smoke detector, a 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 their reach. The LPA did not find any walkers, bouncers, or other comparable objects during its inspection.

There are reportedly no firearms or other weapons on the premises, as stated by the licensee.

The LPA found that the facility did not have any pools, spas, or other types of bodies of water of any kind.

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.

Five different children's files were reviewed by the LPA. All required forms were in the files of the five children. ***See Page 2 for continuation***.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2023

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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Document Has Been Signed on 03/13/2023 11:56 AM - It Cannot Be Edited

Created By: Hanson Leong On 03/13/2023 at 10:38 AM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: ALVAREZ, ALCIRA	FACILITY NUMBER: 214005398
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.622(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above, which poses a potential health, safety or personal rights risk to children in care.
	POC Due Date: 04/13/2023
	Plan of Correction
1 2 3 4	Licensee will provide a copy of her assistsnts' immunzation record by the above due date.

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:

Daniel J Oquendo

LICENSING EVALUATOR NAME:

Hanson Leong

LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2023

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: ALVAREZ, ALCIRA	FACILITY NUMBER: 214005398
	VISIT DATE: 03/13/2023

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Continued, Page 2
The files of the licensee and her assistant were reviewed by the LPA. All required forms were in the files of the licensee. Review of the licensee’s assistant’s immunization record shows she is missing her TDAP vaccination. Review of the training records shows that the licensee is current with her Pediatric First Aid / CPR certifications.

According to the licensee, the facility satisfies the requirements by carrying out simulations of fire and earthquake drills twice a year, as well as by documenting their results.

The following reminders were discussed with the licensee:

1. All adults 18 and over living or working in a licensed childcare facility, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed childcare facility.
2. Incidental Medical Services (IMS) policy
3. As of January 1, 2018, all staff must complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. 4. Regulations for safe sleeping in accordance with the Health and Safety Code. 5. Checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/

The following Type B violation (potential health, safety, or personal rights risk to children in care.) was cited for today’s visit:

1. (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

***The department may clear all violations after the review of the facilities’ Plan of Correction***

A copy of this report, the “Notice of Site Visit”, and the licensee’s appeal rights were given to the licensee.

A “Notice of Site Visit” must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. An exit interview was conducted, and the report was reviewed with the Licensee, Alcira Alvarez

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2023

LIC809 (FAS) - (06/04)

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