214005671-3-7-2025-05-CC-JNAS-DEK3RT-20250307172916

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 214005671
Report Date: 03/07/2025
Date Signed: 03/07/2025 05:29:43 PM

Document Has Been Signed on 03/07/2025 05:29 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:	MORALES, EDINA		FACILITY NUMBER:	214005671
ADMINISTRATOR/ DIRECTOR:	MORALES, EDINA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 948-7617
CITY:	SAN RAFAEL	STATE: CA	ZIP CODE:	94903
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 13	DATE:	03/07/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:40 PM
MET WITH:	Edina Morales		TIME VISIT/ INSPECTION COMPLETED:	05:45 PM

NARRATIVE

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On March 7, 2025, at 2:40pm Licensing Program Analysts (LPAs) Naves and Leong conducted an unannounced annual visit and met with Licensee, Edina Morales. LPAs explained the purpose of the visit to the licensee and was given access to the property.

The licensee and her husband supervised 13 children today, 12 pre-k aged children and 1 school age child. Upon entry, LPAs observed licensee with 12 children by herself that were waking up from nap. Licensee stated husband had just left to go pick up child #13 and would be right back. At 2:50 pm, LPAs observing the husband returning to the home with child # 13.

The licensee and her husband had received criminal record clearances from CDSS. The licensee has current liability insurance for her daycare and the policy was presented to the LPAs.

According to the licensee, 14 children are enrolled in her daycare. LPAs reviewed the children’s roster and found it was not filled out completely. LPA issued one technical violation to the facility for not meeting the one requirement mentioned above.

Daycare areas: Living room, Bathroom, and Two parts of the backyard (the center and left side)

Off-limits areas: Front yard, Rooms # 1, #2, and #3, Garage, Kitchen, Bathroom (inside Room # 3) Right Side of the Backyard surrounded by a fence. The licensee understands that off-limits areas may not be used for childcare during business hours.

LPAs and the Licensee inspected the childcare areas for any potential dangers to health and safety hazards. LPAs observed the childcare areas were in good condition and clean. The toys provided were age-appropriate and included imaginative, creative, and manipulative play.

continued pg 2 >>>>

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jaclyn Naves
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2025

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 03/07/2025 05:29 PM - It Cannot Be Edited

Created By: Jaclyn Naves On 03/07/2025 at 04:17 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: MORALES, EDINA	FACILITY NUMBER: 214005671
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/07/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102416.5(d)

Staffing Ratio and Capacity

(d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above. Licensee was supervising 12 children by herself, which poses/posed a potential health, safety or personal rights risk to children in care.
	POC Due Date: 03/12/2025
	Plan of Correction
1 2 3 4	Licensee will send written plan of correction to prevent out of ratio occurrences. A future visit will also be required to clear deficiency.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Ali Zebila

LICENSING EVALUATOR NAME:

Jaclyn Naves

LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2025

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: MORALES, EDINA	FACILITY NUMBER: 214005671
	VISIT DATE: 03/07/2025

NARRATIVE

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page 2
The outside area had age-appropriate toys and slides. No toys were broken or in disrepair. The outdoor play area has turf that protects from any falls and is gated.

The fireplace is surrounded by a safety gate, which included a safety net. According to the licensee, the front of the home will be the designated isolation area if a child becomes ill while under care.

The facility had a fully charged fire extinguisher that met the minimum standards of 2A 10 BC, along with multiple combinations of carbon monoxide and smoke detectors. LPA tested the carbon monoxide and smoke detector and found them functioning. A functional phone was also available in case of emergencies. A fully equipped first Aid kit was available.

Cleaning agents and detergents were safely stored out of children's reach. According to the licensee, there are no guns or weapons in the home.

All the required posting documentation, such as the facility license, Notification of Parental Rights, and Earthquake Preparedness Checklist, have been placed in a prominent area for parents or representatives to review.

According to the licensee, regular fire and earthquake drills are conducted at least once every month. The latest drill was conducted on 10/10/2024.

6 children's records were reviewed. The licensee maintains accurate records for each child, including vaccination records, parental rights forms, and complete emergency information. These emergency documents contain information such as the child's full name, phone number, and the location of a parent or authorized person who may be contacted in an emergency. The records also contain the name and phone number of the child's doctor and the parent's permission for the licensee to consent to emergency medical care if needed.

LPA reviewed the license and the husband’s file. The licensee’s Pediatric First Aid/CPR certification will expire in January 2027. The licensee’s Mandated Reporter certification expired on February 18, 2025. Per the licensee, she will complete the AB 1207 training as soon as possible. The husband was missing his Tuberculosis (TB) test from his file. Per the licensee, she will email the department with a copy of her husband’s TB test. LPA issued one technical violation to the facility for not meeting the one requirement mentioned above.

CONT PG 3 >>>

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jaclyn Naves
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2025

LIC809 (FAS) - (06/04)

Page: 5 of 7

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: MORALES, EDINA	FACILITY NUMBER: 214005671
	VISIT DATE: 03/07/2025

NARRATIVE

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During the inspection, LPA reviewed Forms/Records to Keep in Your Family Child Care Homes, children's forms/records, and personnel forms/documents with the Licensee. In addition, license capacity and limitations were also reviewed with the licensee. The 80/20 expectation was discussed with licensee.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with the Licensees and discussed the Child Care Licensing Safe Sleep webpage https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed the 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 Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: www.ada.gov/childqanda.htm.

Licensee was reminded about the Provider Information Notices (PINs) on the CCLD website. Licensee was informed that as of September 1, 2016, a person may not be employed or volunteer at a childcare facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.

LPA reviewed AB 1207 with the Licensees. As of January 1, 2018, all staff must complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. Effective July 1, 2020, Licensees must have proof of completion of EMSA certified lead poison training if applying for a change of location or capacity change to an existing license.

cont pg4 >>>>

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jaclyn Naves
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2025

LIC809 (FAS) - (06/04)

Page: 6 of 7

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: MORALES, EDINA	FACILITY NUMBER: 214005671
	VISIT DATE: 03/07/2025

NARRATIVE

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Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

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

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

Appeal rights were given to licensee.

A notice of site visit was given and must remain posted for 30 days.

An exit interview was conducted, and the report was reviewed with the licensee, Edina Morales.

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jaclyn Naves
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2025

LIC809 (FAS) - (06/04)

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