214005711-12-12-2024-05-CC-NGAA-DBVRED-20241212115722

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 214005711
Report Date: 12/12/2024
Date Signed: 12/12/2024 11:57:37 AM

Document Has Been Signed on 12/12/2024 11:57 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:	MAJOULET, HEATHER		FACILITY NUMBER:	214005711
ADMINISTRATOR/ DIRECTOR:	MAJOULET, HEATHER		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 225-5770
CITY:	SAN RAFAEL	STATE: CA	ZIP CODE:	94903
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	12/12/2024
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:28 AM
MET WITH:	Heather Majoulet		TIME VISIT/ INSPECTION COMPLETED:	12:30 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 December 12, 2024, Licensing Program Analyst (LPA) Garcia conducted a scheduled, pre-licensing inspection with the Applicant, Heather Majoulet. The applicant requested a visit from the department due to a relocation. The applicant's previous address was 104 Randolph Drive, Novato, CA 94949 and license number 214005278. 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. Applicant rents this 3 bedroom, 2 bathroom home and documentation of control of property was submitted through email during the inspection. Applicant was able to provide only LIC 9151, without landlord consent form, LIC 9149. Days and hours of operation are Monday - Friday, 6:30-8:30am then 1:00pm- 06:00pm for before and after care. Applicant lives in this home with her minor son and daughter and adult daughter. Licensee states there are two dogs that in the home that do not interact with the children. Day-care areas: Living room, Bathroom #1 and Kitchen/Dining area The off-limit areas: Bathroom #2 and Bedroom #1, #2 and #3, Back Patio Per the Applicant, she plans to utilize bedroom #1 room as an isolation for sick/ill children. Licensee/applicant states that she mostly cares for school aged children. 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/hallway. LPA reminded Heather that all harmful objects, sharp objects, and toxins are stored out of reach of children and made inaccessible to children. Per Heather, she will install cabinet locks in the kitchen. There are First Aid kits available for the children. *continue to 2nd page*

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Nathan Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024

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: MAJOULET, HEATHER	FACILITY NUMBER: 214005711
	VISIT DATE: 12/12/2024

NARRATIVE

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LPA observed that the bathroom is clean, and cleaning products are stored in a cabinet. The applicant states that there are no guns/weapons in the home. Heather states that all electrical outlets will have plastic covers. 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. Per Heather, she will utilize a nearby park within the building complex as an outdoor area.

Applicant plans to serve food for breakfast, lunch and AM/PM snacks, which will be provided also on non-school days. Water will also be provided through bottled water. Heather states that she has Statefarm liability insurance and will send to LPA when she gets a copy of it. 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: 12/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024

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: MAJOULET, HEATHER	FACILITY NUMBER: 214005711
	VISIT DATE: 12/12/2024

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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, 12/12/2024, 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 Heather Majoulet 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, 12/12/2024 the facility will be licensed for a (Small Family Child Care License) a capacity of 6 total children. LPA will not recommend a large FCCH license for the licensee until the San Rafael Fire Department issues a fire clearance for the home, which is a requirement for a large FCCH. Applicant will also send proof of covers and locks on cabinets and outlets and her daughter's immunization records. License will be sent through mail.

Exit interview was conducted and report was reviewed with the applicant, Heather Majoulet.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Nathan Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 12/12/2024 11:57 AM - It Cannot Be Edited

Created By: Nathan Garcia On 12/12/2024 at 11:28 AM

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: MAJOULET, HEATHER	FACILITY NUMBER: 214005711
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/12/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

102357

102357 Operation Without a License (a) If the Department has reason to believe that family child care is being provided without a license, the licensing agency shall: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above, the licensee had to relocate to a new home and provided care at the new location between October 17 until the the last week of November, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 12/13/2024
	Plan of Correction
1 2 3 4	The licensee submitted an application to the department on November 25, 2024. Deficiency cited today will be cleared.

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:

Daniel J Oquendo

LICENSING EVALUATOR NAME:

Nathan Garcia

LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024

LIC809 (FAS) - (06/04)

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