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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005677
Report Date: 03/04/2024
Date Signed: 03/04/2024 03:54:39 PM

Document Has Been Signed on 03/04/2024 03:54 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:VALDIVIA, ELIZABETHFACILITY NUMBER:
214005677
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
03/04/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:26 PM
MET WITH:Elizabeth ValdiviaTIME COMPLETED:
04:09 PM
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On 3/4/2024, Licensing Program Analyst (LPA) Hanson Leong conducted a scheduled pre-licensing visit with the Applicant, Elizabeth Valdivia. On 2/22/2024, the applicant applied for a Small Family Child Care Home (FCCH) license. The applicant requested a visit from the department because she is relocating from another Small FCCH location. The applicant previously held a Small FCCH license under license number 214005637.

The applicant lives with her husband and their four children, all of whom are under the age of 18. The applicant rents the home and intends to operate from 4:00 am to 11:00 pm, Monday through Sunday. The LPA informed the applicant that in the absence of childcare insurance, she must notify her parents or guardians using the LIC 282 form. The applicant plans to care for children aged from newborn to twelve. The applicant intends to provide breakfast, lunch, and one snack.



The applicant provided proof of control of property. The applicant rents/leases the home. Proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).

Parental notification is required if the applicant provides care for a seventh and eighth child who is of school age. Emergency Disaster Plan (LIC 610), Parent's Rights (LIC 995A), and License (once received) are required to be posted in an accessible location where parents can see them.

Daycare areas: Indoor play area, Dining Area, Bedroom # 4 (napping only), Laundry area (diaper changing only), Bathroom #2, and the Outdoor play area

Off-limits areas: Bedrooms #1, 2, 3, Kitchen, Bathroom # 1 All off-limit areas were equipped with child safety locks or safety gate. .


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SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE: DATE: 03/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/04/2024
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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: VALDIVIA, ELIZABETH
FACILITY NUMBER: 214005677
VISIT DATE: 03/04/2024
NARRATIVE
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The LPA and the applicant conducted an inspection to identify any potential health and safety hazards. The LPA observed that a fence surrounds the backyard and has age-appropriate play equipment for children to use. The LPA observed artificial grass and a carpet under the slides to absorb a child’s fall. The LPA found the play equipment in the backyard is both safe and age-appropriate for children. The LPA confirmed the presence of fully operational smoke and carbon monoxide detectors in the home. The applicant’s home has a 2A10BC fire extinguisher and a fully stocked first aid kit. The LPA found the toys, equipment, and learning materials inside the home to be safe and age-appropriate for children

The LPA observed sleeping playpens and sleeping mats in the designated napping area. The LPA observed that a step stool was present in the designated bathroom for the children, and power outlets were properly covered with child safety covers. The LPA observed that safety covers were present on the kitchen stove knobs. The LPA observed that all hazardous materials and toxins were inaccessible to children by keeping them in cabinets with child safety locks. The home has one washing machine and dryer secured with child safety locks. The home has one diaper changing station in the laundry area, which appears clean and safe for the children to use.



The applicant was reminded that their designated cell phone must be kept at home during daycare hours. During today’s inspection, the applicant confirmed that there were no firearms or weapons in the home. The applicant also identified the dining area as the isolation area for a sick child. The LPA reminded the applicant that baby walkers, bouncers, jumpers, and other similar equipment should not be used for children in care.

The LPA reminded the applicant that the CPR and First Aid training must be renewed every two years. The applicant and her husband have provided evidence of receiving MMR and TDAP vaccinations, as well as their TB skin test results. The applicant has completed the Mandated Reporter Training. The LPA informed the applicant that emergency disaster drills should be conducted at least once every six months and that the date and time of the drill should be recorded.

LPA discussed the safe sleep regulations with the applicant 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 the applicant 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
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SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2024
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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: VALDIVIA, ELIZABETH
FACILITY NUMBER: 214005677
VISIT DATE: 03/04/2024
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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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

LPA reviewed with the applicant, the LIC 311D, Forms/Records to Keep in Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. An Entrance Checklist was provided to the applicant. ***See Page 3***



The applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

The applicant 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. The LPA reviewed AB 1207 with the applicant.

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

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

The applicant was advised to contact the San Bruno Regional Office for concerns or questions. Desk Duty is available Monday through Friday, 8:00 am to 5:00 pm at (650) 266-8800. Forms and regulations are made available at www.cdss.ca.gov/inforesources/Community-Care-Licensing.

The LPA will recommend the applicant’s relocation of her Small Family Child Care Home. The license will take effect on 3/4/2024.



A copy of today's report was given to Elizabeth Valdivia. An exit interview was conducted, and the report was reviewed with Elizabeth Valdivia.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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