214005708-2-11-2025-05-CC-NGAA-DDSRNN-20250211121037

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 214005708
Report Date: 02/11/2025
Date Signed: 02/11/2025 12:10:48 PM

Document Has Been Signed on 02/11/2025 12:10 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:	NICOLAS, JOSEPHINE		FACILITY NUMBER:	214005708
ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 1	DATE:	02/11/2025
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:01 AM
MET WITH:	Josephine Nicolas		TIME VISIT/ INSPECTION COMPLETED:	12:35 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On February 11, 2025, Licensing Program Analyst (LPA) Garcia conducted a scheduled, pre-licensing/relocation inspection with the Applicant, Josephine Nicolas. The applicant requested a visit from the department due to a relocation. The applicant's previous address was 4 Hamilton Court, San Rafael, CA 94901 and license number 214005531. The LPA explained the purpose of the visit to the applicant. The Licensee and adults living in the home have cleared background checks, and to be present in a childcare facility. LPA transferred the roster clearances to the new license number during the visit. Applicant owns this 3 bedroom, 2 bathroom home and documentation of control of property was submitted through email during the inspection. Days and hours of operation are Monday - Friday, 6:00am-4:00pm. Applicant lives in this home with her husband, and 2 sons (4 and 7 years old). Licensee states there are no pets, open bodies of water or guns in the home. There was one 1.5 year old child in care during the visit. Day-care areas: Half of the Living room and Dining area, Bathroom #1, Bedroom #1 and #2 and backyard. The off-limit areas: Bathroom #2 and Bedroom #3 and #4, kitchen and front yard. Per the Applicant, she plans to utilize bedroom #1 room as an isolation for sick/ill children. Per applicant, she plans to take care of children ages 6 months through 6 years old. LPA and the Applicant inspected the entire home for Health and Safety Hazards. The home has sufficient lighting and ventilation. There are a variety of age-appropriate toys, puzzles, posters and books for the children. There are multiple sensory blocks/table and imaginative kitchen toys. All furniture and playthings were observed to be in good repair. The Applicant's home has smoke detectors and a carbon monoxide detectors installed. During the inspection, fire/carbon monoxide alarms were tested and verified functionality. The home has a Fire Extinguisher model 3A10BC located in the kitchen. LPA reminded Josephine that all harmful objects, sharp objects, and toxins are stored out of reach of children and made inaccessible to children. Josephine installed a barricade and child proof locks on the kitchen drawers during the inspection. There's a First Aid kit available for the children. LPA observed hanging metal fence on the backyard and wooden boards on the ground with screws. LPA advised applicant to remove both objects as soon as possible and to put a barricade to prevent children from going to the side of the home where there are potential hazardous materials. *continue to 2nd page*

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Nathan Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 02/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2025

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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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: NICOLAS, JOSEPHINE	FACILITY NUMBER: 214005708
	VISIT DATE: 02/11/2025

NARRATIVE

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LPA observed that the bathroom is clean, and cleaning products are stored in a locked cabinet. LPA reminded the Applicant to conduct an emergency drill at least once every six months and document the drills. The applicant was given a template that she may use to keep track of the fire drills and the infant sleeping log. The Applicant was informed that NO baby walkers, exer-saucers, jumpers, bouncers, and any similar items to be used for children in care. The Applicant was also reminded that smoking is prohibited at the day-care.

Applicant plans to serve food for breakfast, lunch and AM/PM snacks. Water will also be provided through filtered pitcher. Josephine states that she is applying for liability insurance. Applicant's Pediatric First Aid CPR and Mandated Reporter Training are valid, and copies have been submitted to the Department. LPA reminded applicant to renew the certificates every two years.

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, 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 applicant, and discussed the Child Care Licensing Safe Sleep web page at:https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed 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 recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

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SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Nathan Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 02/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2025

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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: NICOLAS, JOSEPHINE	FACILITY NUMBER: 214005708
	VISIT DATE: 02/11/2025

NARRATIVE

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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: http://www.ada.gov/childqanda.htm

On this date, 2/11/25, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Applicant was informed of the MyChildCarePlan.org site, 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.

LPA reviewed with Josephine Nicolas 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
Entrance Checklist was provided to the applicant.

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 platform.
To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

As of today, 2/11/2025 the facility will be licensed for a (Small Family Child Care License) a capacity of 8 total children ONCE the applicant sends proof of additional door knob locks and the corrections discussed with the applicant for the backyard. License will be sent through mail.

Exit interview was conducted and report was reviewed with the applicant, Josephine Nicolas.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Nathan Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 02/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2025

LIC809 (FAS) - (06/04)

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