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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005677
Report Date: 05/14/2024
Date Signed: 05/14/2024 10:46:40 AM

Document Has Been Signed on 05/14/2024 10:46 AM - 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/
DIRECTOR:		VALDIVIA, ELIZABETHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 755-7392
CITY:SAN RAFAELSTATE: CAZIP CODE:
94901
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 12DATE:
05/14/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:46 AM
MET WITH:Elizabeth ValdiviaTIME VISIT/
INSPECTION COMPLETED:
10:55 AM
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On 5/14/2024, Licensing Program Analyst (LPA) Hanson Leong conducted an unannounced case management visit to the Family Childcare Home (FCCH) listed above. The licensee asked the department to visit and approve adding one of the bedrooms to her daycare. LPA met with the Licensee, Elizabeth Valdivia, and explained the purpose of the visit. During the visit, eight preschool-aged children, four infants, the licensee, the licensee's husband, and the licensee’s daughter (under 18) were present at FCCH. Both the licensee and her husband, who were present, had received their criminal record clearance from the department. The FCCH was operating within its capacity and adhering to the required staff-to-child ratio.

A request was made to include Bedroom #1 in the daycare facility. Bedroom #1 was found to be clean, sanitary, and free of defects. It was equipped with a carbon monoxide and smoke detector and contained playpens, mats, cribs, and a safety gate at the entrance. Electrical outlets were also appropriately covered. Approval for Bedroom #1 will be granted during today’s visit.

A second request was made to remove Bedroom #4 from the daycare facility, which will be approved by the LPA. LPA reminded the licensee that Bedroom #4 should not be utilized during daycare hours, and any intended usage of different areas within the daycare requires prior approval from the department.

No deficiencies were issued today during LPA's visit.

A copy of today's report was given to the Licensee, Elizabeth Valdivia.

A Notice of Site Visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee, Elizabeth Valdivia.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE: DATE: 05/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/14/2024
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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