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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005677
Report Date: 03/28/2024
Date Signed: 03/28/2024 02:48:57 PM

Document Has Been Signed on 03/28/2024 02:48 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: 5DATE:
03/28/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:43 PM
MET WITH:Eilzabeth ValdiviaTIME COMPLETED:
03:00 PM
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On 3/28/2024, Licensing Program Analyst (LPA) Hanson Leong conducted an unannounced case management visit to the Family Childcare Home (FCCH) listed above. The licensee requested a visit from the department because she would like to upgrade her small FCCH to a large FCCH license. During the visit, the LPA met with the Licensee, Elizabeth Valdivia, and explained the purpose of the visit. During the visit, two infants, two preschool-aged children, licensee’s daughter (preschool-aged), licensee’s second daughter (13 years old), and licensee’s husband were present. The licensee and the licensee’s husband present at the FCCH have all received a criminal record clearance from the department. The FCCH operates within its capacity and in accordance with the required ratio of staff to children.

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

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

LPA and the licensee conducted an inspection to identify any potential health and safety hazards. LPA observed that the indoor daycare areas were 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, functioning smoke detectors and carbon monoxide detectors, and a fully charged fire extinguisher. LPA observed that all garbage cans and power outlets are appropriately covered. LPA observed that all cleaning and washing products, along with other harmful materials, are out of reach of children by



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SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE: DATE: 03/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/28/2024
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: 03/28/2024
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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. According to the licensee, no firearms or weapons are on the premises

LPA observed that the entire backyard is fully enclosed and fenced. LPA observed that the outdoor playground equipment and furniture were 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 stairs in the outdoor play area were properly secured with a safety gate. LPA observed that the FCCH has no pools, spas, or other bodies of water.



LPA reminded the licensee that care must be provided within the capacity limits specified in the license. The capacity limits of a large license have been reviewed with the licensee. The licensee is reminded that if no assistant provider is present at a large family childcare home, the licensee shall comply with the capacity requirements for a small family childcare home. LPA reminded the licensee that a Small Family Childcare Home may provide care for more than six and up to eight children,

LPA reminded the licensee that she is required to be physically present in the home and is responsible for ensuring that all children in care are always supervised. If the provider needs to leave the home for a short period of time, they must arrange for a substitute adult to care for and supervise the children during their absence. The temporary absences must not exceed 20 percent of the hours that the facility is providing care for per day.

The San Rafael Fire Department issued a fire clearance for the FCCH on 3/26/2024, as required for a large FCCH.

LPA will recommend a large FCCH license for the licensee. The large license will take effect on 3/28/2024.

No deficiencies were issued today during LPA's visit.

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

Exit interview conducted and report was reviewed with the Licensee, Elilzabeth Valdivia. .

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

DATE: 03/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024
LIC809 (FAS) - (06/04)
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