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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005623
Report Date: 03/21/2024
Date Signed: 03/21/2024 01:35:22 PM

Document Has Been Signed on 03/21/2024 01:35 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:ACQUA TODDLER HOUSEFACILITY NUMBER:
214005623
ADMINISTRATOR:MENDOZA, NICOLASFACILITY TYPE:
830
ADDRESS:96 PILGRIM WAYTELEPHONE:
(415) 755-7075
CITY:SAN RAFAELSTATE: CAZIP CODE:
94903
CAPACITY: 16TOTAL ENROLLED CHILDREN: 16CENSUS: 6DATE:
03/21/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:37 AM
MET WITH:Nico MendozaTIME COMPLETED:
01:50 PM
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On 3/21/2024, Licensing Program Analyst (LPA) Hanson Leong conducted an unannounced required visit to the Child Care Center (CCC) listed above. During the visit, LPA met the Director, Nico Mendoza, and explained the purpose of the visit. Present in the CCC during the visit: six children (three toddlers and three infants) and four staff members. The director and the three staff members present at the CCC have received fingerprint clearance from the department. The CCC operates within its capacity and in accordance with the required ratio of staff to children.

LPA observed that all required documents, such as the facility license, waivers, notification of parental rights, notification of personal rights, car seat law, emergency disaster plan, and daily activities, were displayed in the CCC. According to the director, the CCC has not conducted emergency disaster drills. During the visit, an emergency disaster drill template was given to the director.

LPA observed that the CCC maintains a paper record of the children’s attendance, with corresponding parental signatures, and all enrolled children are accounted for during the day.

LPA and the director conducted an inspection to identify any potential health and safety hazards. LPA observed that the inside of the CCC appeared to be clean, safe, sanitary, and in good repair. The CCC is equipped with a fully stocked first aid kit, functioning smoke detectors and carbon monoxide detectors, and a fully charged fire extinguisher. LPA observed that the classrooms were equipped with age-appropriate toys, furniture, and educational materials. LPA observed that each child has an individual permanent or portable storage space for his/her clothing, personal belongings, and/or bedding at the CCC.



LPA observed bathrooms to be clean and in working condition. Garbage bins in bathrooms were observed to have tight-fitting lids. The sink was observed to be in working condition and not providing water warmer than 120 degrees Fahrenheit. LPA observed all toilets, handwashing, and bathing facilities at the CCC appeared to be in safe and sanitary operating condition.

LPA observed that all accessible cabinets and drawers in classrooms did not contain hazardous materials or poisons. LPA observed that poisons, cleaning solutions, and chemicals were stored on high shelves or shelves with child safety locks to make them inaccessible to children in the classroom.

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SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE: DATE: 03/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/21/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: ACQUA TODDLER HOUSE
FACILITY NUMBER: 214005623
VISIT DATE: 03/21/2024
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According to the director, the children are responsible for bringing their own lunch to the CCC. LPA observed that the children brought their own lunch boxes and water bottles. LPA observed that the lunch boxes and water bottles were of different colors, making them easy to distinguish from each other. .

LPA observed that a half door was present between the two different age groups.

LPA observed that a fence enclosed the outdoor playground and that the equipment and furniture appeared to be in good condition. The areas around and under high climbing equipment, swings, slides, and similar equipment were cushioned with material that absorbs falls. LPA observed that the CCC did have a fish pond in the toddler room, which was secured with a cover.

LPA observed that the CCC has a specific sleeping/resting area for children. The area was equipped with cribs, cots, mats, and blankets, which appeared to be comfortable and safe for the children to sleep in. LPA observed a clean diaper-changing station within arm’s reach of an adult sink, complete with wipes and diapers. Both the classroom and diaper disposal bins had tight-fitting lids. The mattresses appeared to be firm and covered with a fitted sheet appropriate to their size. The sheets appeared to fit tightly on the mattresses and overlapped the underside of the mattresses.

LPA reviewed the records of both the children and staff members. LPA reviewed the six children's records and found that four files contained all necessary documents, including their Immunization Record, Admission Agreement, Personal Rights Identification and Emergency Information, Physician's Report, Notification of Parents' Rights, and Consent for Emergency Medical Treatment. LPA provided the form LIC 125 to the director, which identifies the required forms for enrolled children.



LPA reviewed the records of three staff members and confirmed that their Pediatric First Aid/CPR certification was not current. LPA confirmed that one staff member completed their twelve units for Early Childhood Education, qualifying them as a teacher. LPA observed that the sleep log for children under two years old was missing, which must be completed every fifteen minutes. During the visit, an infant sleeping log template was given to the director. LPA reminded the director that each staff member must have their immunization record and TB test in their file.
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SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2024
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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: ACQUA TODDLER HOUSE
FACILITY NUMBER: 214005623
VISIT DATE: 03/21/2024
NARRATIVE
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Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.

For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP).

LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

Director was reminded that all adults 18 and over, 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 Child Care Center. 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 director 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 director 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, an updated Plan of Operation that includes 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) 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-care-centers
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SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2024
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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: ACQUA TODDLER HOUSE
FACILITY NUMBER: 214005623
VISIT DATE: 03/21/2024
NARRATIVE
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Director 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.

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

Please refer to LIC 809D for today’s citations.

Appeal Rights were given to the Director, Nico Mendoza.

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

Exit interview conducted and report was reviewed with the Director, Nico Mendoza.

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

DATE: 03/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2024
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Document Has Been Signed on 03/21/2024 01:35 PM - It Cannot Be Edited


Created By: Hanson Leong On 03/21/2024 at 01:00 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: ACQUA TODDLER HOUSE
FACILITY NUMBER: 214005623

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/21/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101174(d)
Disaster and Mass Casualty Plan
(d) Disaster drills shall be conducted at least every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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3
4
Based on interview and record review, the licensee did not comply with the section cited above, which poses/posed a potential health, safety or personal rights risk to children in care.
POC Due Date: 04/21/2024
Plan of Correction
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Proof of emergency disaster drill must be submitted to the department by the due date mentioned above.
Type B
Section Cited
CCR
101174(d)(2)
Disaster and Mass Casualty Plan
(d) Disaster drills shall be conducted at least every six months. (2) The drills shall be documented. This documentation shall be kept in the child care center for at least one year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above, which poses/posed a potential health, safety or personal rights risk to children in care.
POC Due Date: 04/21/2024
Plan of Correction
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Proof of emergency disaster drill must be submitted to the department by the due date mentioned above.
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: 03/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/21/2024


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Document Has Been Signed on 03/21/2024 01:35 PM - It Cannot Be Edited


Created By: Hanson Leong On 03/21/2024 at 01:00 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: ACQUA TODDLER HOUSE
FACILITY NUMBER: 214005623

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/21/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216(f)
Personnel Requirements
(f) At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above, which poses/posed a potential health, safety or personal rights risk to children in care.
POC Due Date: 04/21/2024
Plan of Correction
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A current CPR/First Aid certificate must be submitted to the department by the due date mentioned above.
Type B
Section Cited
CCR
101429(a)(2)(C)(3)
Responsibility for Providing Care and Supervision for Infants
(C) Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: (3) Time of each 15-minute check

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above, which poses/posed a potential health, safety or personal rights risk to children in care.
POC Due Date: 04/21/2024
Plan of Correction
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Director must submit sleeping logs for all children under the age of two to the department by the due date mentioned above.
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: 03/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/21/2024


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