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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005398
Report Date: 03/15/2024
Date Signed: 03/15/2024 01:27:19 PM

Document Has Been Signed on 03/15/2024 01:27 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:ALVAREZ, ALCIRAFACILITY NUMBER:
214005398
ADMINISTRATOR:ALVAREZ, ALCIRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 728-5449
CITY:SAN RAFAELSTATE: CAZIP CODE:
94903
CAPACITY: 10TOTAL ENROLLED CHILDREN: 10CENSUS: 6DATE:
03/15/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
10:22 AM
MET WITH:Alcira Alvarez and Maria AlvarezTIME COMPLETED:
01:40 PM
NARRATIVE
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On 3/15/2024, Licensing Program Analysts (LPAs) Hanson Leong and Melissa Zaragoza conducted an unannounced required visit to the Family Childcare Home (FCCH) listed above. During the visit, LPAs met the facility representative, Maria Alvarez, and explained the purpose of the visit. At 10:55 am, the Licensee, Alcira Alvarez, arrived at the FCCH. Present in the home during the visit: six children (three infants and three preschool-aged children) and three staff members. The three staff members present at the FCCH have received fingerprint clearance from the department. The FCCH operates within its capacity and in accordance with the required ratio of staff to children.

Daycare Areas: Living room, Balcony adjacent to living room, Full bathroom, Half bathroom, and Bedroom #2.

Off Limit Area(s): Bedroom #1, Kitchen, and Closet in the hallway. The licensee understands that off-limits areas may not be used for childcare during business hours.



LPAs and the licensee conducted an inspection to identify any potential health and safety hazards. LPAs observed that the indoor daycare areas appeared to be clean and orderly. LPAs observed that the indoor daycare areas were equipped with age-appropriate toys, furniture, and educational materials. The FCCH is well-lit, ventilated, and free of hazards that could endanger children. The FCCH is equipped with a fully stocked first aid kit, a functioning smoke detector and carbon monoxide detector, and a fully charged fire extinguisher. LPAs observed that all garbage cans and power outlets were appropriately covered. LPAs observed that bleach, laundry detergent, glass cleaner, toilet cleaner, and a Lysol disinfectant spray were inside an unlocked closet. LPAs observed that a Lysol disinfectant spray and mouthwash were in an unlocked cabinet under the sink in the Full Bathroom. LPAs observed that no equipment, such as walkers, bouncers, or similar objects, was present in the FCCH. LPAs observed a safety gate surrounding the balcony. According to the licensee, no firearms or weapons are on the premises.

According to the licensee, there was a swimming pool on the property. The LPAs observed concrete covering the pool. LPAs observed that the FCCH has no pools, spas, or other bodies of water
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SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE: DATE: 03/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/15/2024
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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Document Has Been Signed on 03/15/2024 01:27 PM - It Cannot Be Edited


Created By: Hanson Leong On 03/15/2024 at 12:32 PM
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: 03/15/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above, which poses an immediate health, safety or personal rights risk to children in care.
POC Due Date: 03/18/2024
Plan of Correction
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A follow up visit is required to ensure cleaning products and chemicals are properly secured and inaccessible to children.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: 03/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/15/2024


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: ALVAREZ, ALCIRA
FACILITY NUMBER: 214005398
VISIT DATE: 03/15/2024
NARRATIVE
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LPAs observed that the FCCH has a specific sleeping/resting areas for children. The areas were equipped with playpens, cots, mattresses, and blankets, which appeared to be comfortable and safe for the children to sleep in. LPAs also observed a clean diaper-changing station in the Full Bathroom, complete with wipes and diapers. The infant mattresses appeared to be firm and covered with a fitted sheet appropriate to their size. The sheet appeared to fit tightly on the mattress and overlapped the underside.

The LPAs observed that all required documents, such as the facility license, the Notification of Parental Rights, and the Earthquake Preparedness Checklist, were displayed in the FCCH. According to the licensee, the most recent emergency drill was conducted in Dec 2033. The LPAs reminded the licensee that emergency drills must be documented and conducted every six months. The FCCH’s most recent emergency disaster drill, conducted on January 17, 2024, was properly recorded, as confirmed by the LPA's review of the log.



The LPAs reviewed the records of both the children and staff members. According to the licensee, she carries childcare insurance for a FCCH with Markel Insurance Company. The LPAs reviewed the five children's records and found that three files contained all necessary documents, including their Immunization Record, Identification/Emergency Information, Consent for Emergency Medical Treatment, and Notification of Parents’ Rights. The LPAs provided the licensee with two forms, LIC 126, Entrance Checklist for an FCCH, and LIC 9227, Individual Infant Sleeping Plan, which are required forms for the children in care. The LPAs reviewed the sleeping records of the two children under two and determined that the data was properly recorded. The licensee was reminded that a sleep log is required for children under two years old. Following a review of the staff records, the LPAs found that the licensee and the licensee's assistant possess a current certification in Pediatric First Aid/CPR. The licensee’s Pediatric First Aid/CPR certification expires on 5/2024. The LPAs reminded that the Mandated Reporter training certificate for all three staff members, the two assistant’s TB skin test, and the two assistant's immunization record must be submitted to the department as soon as possible.

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.

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SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE:

DATE: 03/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2024
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: ALVAREZ, ALCIRA
FACILITY NUMBER: 214005398
VISIT DATE: 03/15/2024
NARRATIVE
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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/.

LPAs 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. LPAs 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 LPAs completed the RSO profile in FAS.

On this date, 3/15/2024, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

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.

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SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE:

DATE: 03/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2024
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: ALVAREZ, ALCIRA
FACILITY NUMBER: 214005398
VISIT DATE: 03/15/2024
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The LPAs informed the licensee to provide a copy of this licensing report dated 3/15/2024 that documents any Type A citations to the parents or guardians of all children currently enrolled by the next business day or the next day the children are in care and to the parents or guardians of any newly enrolled children for a period of 12 months from the date of this report. The deadline for providing this information is the next day, 3/18/2024, the children are in care. For the purposes of verification, the child's file needs to have either a signed Acknowledgement of Receipt of Licensing Report (LIC 9224) or another type of written statement.

Please refer to LIC 809D for today's citation

Appeal Rights were given to the the Licensee, Alcira Alvarez

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

Exit interview conducted and report was reviewed with the Licensee, Alcira Alvarez



SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE:

DATE: 03/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2024
LIC809 (FAS) - (06/04)
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