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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005632
Report Date: 03/22/2024
Date Signed: 03/22/2024 03:50:03 PM


Document Has Been Signed on 03/22/2024 03:50 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:COSTA, DARCI & COSTA, LIA CRISTINAFACILITY NUMBER:
214005632
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 2DATE:
03/22/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:22 PM
MET WITH:Darci CostaTIME COMPLETED:
04:00 PM
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On 3/22/2024, Licensing Program Analyst (LPA) Hanson Leong conducted an unannounced annual visit to the Family Childcare Home (FCCH) listed above. During the visit, LPA met the Licensee, Darcia Costa and explained the purpose of the visit. During the visit, the second licensee was not present in the FCCH. Present in the FCCH during the visit: two children (one infant and one preschool-aged child) and the licensee. The licensee 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. During the visit, there was a dog present in the FCCH.

LPA 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, she has not conducted emergency disaster drills for the FCCH. LPA reminded the licensee that emergency disaster drills must be documented and conducted every six months.



According to the licensee, lunch and snacks are provided to the children. LPA reminded the licensee about the importance of sanitation and proper preparation of food.

Daycare Areas: Living Room, Dining Room, Bedroom #1, and Bathroom #1,

Off Limit Area(s): Bedroom #2, Bedroom #3, Bathroom #2, and Kitchen. The licensee understands that off-limits areas may not be used for childcare during business hours.

LPA and the licensee conducted an inspection to identify any potential health and safety hazards. LPA observed that the indoor daycare areas appeared to be clean and orderly. LPA 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.


See Page 2
SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson LeongTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 03/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/22/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4


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: COSTA, DARCI & COSTA, LIA CRISTINA
FACILITY NUMBER: 214005632
VISIT DATE: 03/22/2024
NARRATIVE
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LPA observed that all garbage cans and power outlets were appropriately covered. LPA observed that all cleaning and washing products, along with other harmful materials, are out of reach of children by placing them on high shelves or locking them with a child safety lock. LPA observed that no equipment, such as walkers, bouncers, or similar objects, was present in the FCCH. LPA observed that feeding chairs were available in the FCCH. According to the licensee, no firearms or weapons are on the premises. LPA observed that the FCCH has no pools, spas, or other bodies of water.

LPA observed that the FCCH has a specific sleeping/resting area for children. The area is equipped with a playpen, cots, and blankets, which appeared to be comfortable and safe for the children to sleep in. LPA also observed a diaper-changing mat. LPA observed there were wipes and diapers available in the FCCH. The mattresses appeared to be firm and covered with a fitted sheet appropriate to their size. The sheets appeared to fit tightly on each mattress.

LPA reviewed the records of both the children and staff members. According to the licensee, she doesn't have childcare insurance, which isn't required for a FCCH. LPA reviewed the two children's records and found that one file contained all necessary documents, including their Immunization Record, Identification/Emergency Information, Consent for Emergency Medical Treatment, and Notification of Parents’ Rights. LPA provided the licensee with the form, LIC 126, Entrance Checklist for an FCCH, which identifies the required forms for the children in care. According to the licensee, she does not have a sleeping log for children under the age of two. The licensee was reminded that a sleep log is required for children under the age of two. During today’s visit, LPA provided a sample sleeping log to the licensee.



Following a review of the staff records, LPA found that the licensee possesses a current certification in Pediatric First Aid/CPR, which expires on 7/2024.

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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SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson LeongTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: COSTA, DARCI & COSTA, LIA CRISTINA
FACILITY NUMBER: 214005632
VISIT DATE: 03/22/2024
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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/.

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.

On this date, 3/22/2024, 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.

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

Appeal Rights were given to the Licensee, Darci Costa.

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

Exit interview conducted and report was reviewed with the Licensee, Darci Costa. .

SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson LeongTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 03/22/2024 03:50 PM - It Cannot Be Edited

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: COSTA, DARCI & COSTA, LIA CRISTINA
FACILITY NUMBER: 214005632

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/22/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)(D)(c)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: 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: 04/05/2024
Plan of Correction
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Licensee must submit a sleeping log for each child under the age of two by the due date mentioned above.
Type B
Section Cited
CCR
102417(g)(9)(A)
(A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

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: 04/05/2024
Plan of Correction
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Licensee must submit proof that an emergency disaster drill was conducted 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 OquendoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson LeongTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 03/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/22/2024
LIC809 (FAS) - (06/04)
Page: 4 of 4