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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005640
Report Date: 07/03/2024
Date Signed: 07/03/2024 04:44:47 PM

Document Has Been Signed on 07/03/2024 04:44 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:DUARTE, ANGELINA F.FACILITY NUMBER:
214005640
ADMINISTRATOR/
DIRECTOR:		DUARTE, ANGELINA F.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 464-0221
CITY:MILL VALLEYSTATE: CAZIP CODE:
94941
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
07/03/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:10 PM
MET WITH:Licensee, Angelina DuarteTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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On 7/3/2024, at approximately 3:10PM, Licensing Program Analyst (LPA) Jonathan Tse conducted an unannounced annual visit at the facility. LPA met with Licensee, Angelina Duarte (L1). LPA explained the purpose of the visit. Present during the visit was L1, a helper, three infants, and one preschool age child. The facility is in compliance with staffing and ratio requirements on this day. The facility’s operating hours are from 7:30AM to 5:30PM, Monday to Friday.

Daycare areas: Main Daycare Area, Sunroom Daycare Area, Bedroom #1 (Napping only), Side yard, Backyard, and a Bathroom.
Off-limits areas: Family Room, Kitchen, Office, Master Bedroom, Bedroom #2, Bedroom # 3, and a Second Sideyard.

LPA inspected the home for any health or safety hazards. The home is equipped with two fully charged 2A10BC fire extinguishers. There are operational carbon monoxide detectors present in the day care areas. There is a fire alarm system running throughout the facility. Emergency exits are clearly labeled and visible. There is a fireplace in the Main Daycare Area that has been obstructed by furniture. Electrical outlets are covered or obstructed by furniture to be inaccessible to children in care. Poisons, cleaning detergents, and other chemicals are stored inaccessible to children in care. Off-limits areas are rendered inaccessible with childproof gates or locks.

LPA observed the daycare areas to be equipped with age-appropriate toys and learning materials. Furniture is age-appropriate and free of rough or sharp edges. LPA observed highchairs to be used only for feeding purposes. There is at least one crib available for each infant in care. Per L1, mats are provided by the facility and cleaned once a week. The facility provides breakfast, lunch, and snacks. Children bring water bottles from home and they are refilled at the facility as needed.
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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE: DATE: 07/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/03/2024
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: DUARTE, ANGELINA F.
FACILITY NUMBER: 214005640
VISIT DATE: 07/03/2024
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LPA observed the Backyard to be free of debris and other loose articles. There are age-appropriate toys and equipment present. There is resilient padding in the form of artificial turf. Toys and equipment are cleaned and sanitized. The Backyard is enclosed by a fence that is at least four feet high. LPA observed the fence to be in good repair. There are no pools or other bodies of water in the facility. Per Licensee, there are no firearms or weapons in the home.

LPA reviewed two staff files, four children’s files, and facility records. Licensee’s Pediatric First Aid/CPR expires 3/2025. Licensee’s Mandated Reporter Training expires 4/2025. Immunization records are available for review. All children’s files were observed to be complete. Infant sleeping logs are maintained electronically and available for review. LPA discussed the following forms with Licensee: Individual Infant Sleeping Plan (LIC9227) and Parent Notification of Additional Children in Care (LIC9150). LPA observed all required postings to be posted and accessible for review immediately upon entry to the facility. The last emergency drill was conducted in 4/2024, and logs are posted with the required postings.

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.

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: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2024
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: DUARTE, ANGELINA F.
FACILITY NUMBER: 214005640
VISIT DATE: 07/03/2024
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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.

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/.

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, Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

No deficiencies were cited during today’s visit on 7/3/2024.
A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Angelina Duarte.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2024
LIC809 (FAS) - (06/04)
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