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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005509
Report Date: 02/02/2024
Date Signed: 02/02/2024 11:46:06 AM

Document Has Been Signed on 02/02/2024 11:46 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:PAZ, NAYARA O.P. AND RONCATO, BRUNO R.FACILITY NUMBER:
214005509
ADMINISTRATOR:PAZ, NAYARA O.P.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 578-2515
CITY:SAN RAFAELSTATE: CAZIP CODE:
94903
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
02/02/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Nayara PazTIME COMPLETED:
11:55 AM
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On 2/2/2024 at 9:00AM., Licensing Program Analysts (LPA), Luis J. Gomez met with Licensee, Nayara Paz. Purpose of the visit was explained and was for an Unannounced; Annual Random Inspection. Present was the licensee and two assistants caring for 8 children (4 Infant-age, 4 Preschool- age). Per licensee, infant-age child present is her daughter. The adults present have criminal record clearances on file. Licensee’s home is a three bedroom, two bathroom, one level house. Licensee’s days and hours of operation are: Monday- Friday: 8:00am- 5:00pm. The areas of the home used for care are: Living Room (Playroom); Dining Area; Bathroom #1; Bedroom #1 (Napping Only); Master bedroom (Napping Only); and Backyard. The areas of the home designated as off- limit are: Bedroom #2; Living Room #2; Kitchen Area; and Garage. LPA inspected home for health and safety hazards.

At 9:10AM., the following was observed: Facility was clean, orderly with age-appropriate playthings available for the children. Accessible furniture, toys, and books inspected were in good repair. Labeled cubbies are available in playroom for storage of belongings. The facility has child- sized tables and chair, with wide- based highchairs available for food services. For nap services, LPA observed several infant cribs/ play pens located in bedroom #1, with tight-fitting sheets. Facility was equipped with one crib/ plan pen for each infant in care. Bathroom #1 was maintained clean with supplies for hand washing. Facility was the proper temperature with ventilation and lighting. Off-limit areas have been made inaccessible with installed safety gates. Home had functioning telephone service; carbon monoxide detector; smoke detector; and fire extinguisher: 3A:40:BC, located under sink.

At 9:30AM., LPA inspected the backyard area. Area was completely enclosed with tall fencing, with playthings inspected were in good repair. Home does not have any pools, fishponds, jacuzzi or bodies of water. LPA reminded licensee to remove all hazardous plants from the backyard area. Facility shed was reviewed during inspection.


(REFER TO 809C, FOR CONT)
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 02/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/02/2024
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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: PAZ, NAYARA O.P. AND RONCATO, BRUNO R.
FACILITY NUMBER: 214005509
VISIT DATE: 02/02/2024
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At 10:00PM., LPA reviewed facility records including the children’s files and staff files. Children’s files were reviewed and included the: Identification of Emergency Information (LIC702); Notification of Parent’s Rights; and Immunization Records; Individual Infant Sleeping Plan (LIC9227); and Infant Napping Logs.

The staff files were reviewed and included the: Notice of Employee Rights (LIC9052); Required ‘Mandated Reporter Training’ certification (AB1207); and Acknowledgement to Report Suspected Child Abuse (LIC9108). LPA reminded licensee to ensure all staff’s proof of required immunization are stored in facility records.

Licensee’s Cardiopulmonary Resuscitation/ First Aid Certification (CPR) was current, expiring: 9/2025.
Licensee’s ‘Mandated Reporter Training’ was current, expiring: 12/2025.

Licensee is conducting emergency disaster drill every 6 months with last drill completed on 8/10/2023, properly logged.

The required forms are posted in facility, including the Facility License; Notification of Parent’s Rights (PUB379); and Emergency Disaster Plan (LIC610A).

Per licensee, isolation of an ill child is in the playroom. Per licensee, she provides food service for children in care. LPA advised licensee to ensure all children’s food containers brought by families are be labeled.


(REFER TO 809C, FOR CONT.)
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2024
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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: PAZ, NAYARA O.P. AND RONCATO, BRUNO R.
FACILITY NUMBER: 214005509
VISIT DATE: 02/02/2024
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Licensee was reminded that all adults 18 years and over living in the home, person who provides care and supervision to children, and staff who have contact with children, including employee and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain criminal 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.

LPA discussed the safe sleep regulations with licensee and discussed Child Care Licensing Safe Sleep Web page at:https://www.cdss.ca.gov/inforesource/child-care-licesning/public-information-and-resources/safe-sleep as an additional resource. LPA informed licensee of the importance of checking for recalled infant devices on United States consumer Product Safety Commission (CPSC) website at http://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 www.mychildcareplan.org site is a consumer education website that helps families obtain child care by connecting to child care providers and resources and referral agencies (R&R) throughout California.

Incidental Medical Services (IMS) policy was discussed. For IMS information, see PIN 20-02-CCP. When an IMS is provided, a plan for 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- 0382 (TTY) and link to publications: Commonly asked questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

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 tool, please send them 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/inforesource/community-care-licensing/inspection-process.

Based on today's inspection, no deficiencies were observed in areas evaluated according to California Title 22, Div. 12 Chap. 3, Health and Safety, Code of Regulations. Exit interview and Facility Evaluation Report was reviewed with Licensee, Nayara Paz. Licensee’s signature of this form acknowledges the receipt of these documents.

During exit interview, licensee, Nayara Paz confirmed that there are no registered sex offenders living in the facility, and LPA completed the RSO profile. Notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2024
LIC809 (FAS) - (06/04)
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