<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214200004
Report Date: 07/23/2024
Date Signed: 07/23/2024 12:51:36 PM

Document Has Been Signed on 07/23/2024 12:51 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:ANDRADE-WOLF, ANAFACILITY NUMBER:
214200004
ADMINISTRATOR/
DIRECTOR:		ANDRADE-WOLF, ANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 299-0862
CITY:SAN RAFAELSTATE: CAZIP CODE:
94903
CAPACITY: 14TOTAL ENROLLED CHILDREN: 5CENSUS: 5DATE:
07/23/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:25 AM
MET WITH:Ana Andrade WolfTIME VISIT/
INSPECTION COMPLETED:
01:00 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 7/23/2024, Licensing Program Analyst (LPA) Hanson Leong conducted an unannounced annual visit to the Family Childcare Home (FCCH) listed above. LPA met with the Licensee, Ana Andrade Wolf, and explained the purpose of the visit.

Five children (one infant and four pre-k) and three adults (the licensee and the licensee's two assistants) were present during the visit. The three adults received criminal record clearance from the department. The licensee holds a large license and is within capacity limits and ratios.

The licensee owns the home and lives with her husband. The hours of operation are Monday through Friday from 8:00 a.m. to 4:00 p.m. One dog was present in the home. According to the licensee, the dog is fully vaccinated.

LPA observed that all required documents, such as the facility license, the Notification of Parental Rights, and the Earthquake Preparedness Checklist, were displayed in a prominent, publicly accessible location.

The most recent emergency disaster drill was conducted on 5/8/2024, and the LPA observed that it was properly documented. LPA reviewed the emergency disaster drill log and found that they were conducted every six months.

Day-care Areas: Backyard, Playroom, Living Room, Bedroom #1, and Bathroom #1

Off Limit Areas: Office, Bedroom #2, Bathroom #2, and Garage. The licensee understands that off-limits areas may not be used for childcare during business hours.

See Page 2

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE: DATE: 07/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/23/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 5
Document Has Been Signed on 07/23/2024 12:51 PM - It Cannot Be Edited


Created By: Hanson Leong On 07/23/2024 at 11:45 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: ANDRADE-WOLF, ANA
FACILITY NUMBER: 214200004

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/23/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

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, which poses/posed a potential health, safety or personal rights risk to children in care.
POC Due Date: 07/30/2024
Plan of Correction
1
2
3
4
The licensee stated that she would provide the assistant’s immunization records to the department by the due date mentioned above.
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:Hanson Leong
LICENSING EVALUATOR SIGNATURE:
DATE: 07/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/23/2024


LIC809 (FAS) - (06/04)
Page: 2 of 5
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: ANDRADE-WOLF, ANA
FACILITY NUMBER: 214200004
VISIT DATE: 07/23/2024
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
26
27
28
29
30
31
32
Page 2

LPA conducted inspections of the indoor and outdoor daycare areas to identify health and safety hazards. A fire extinguisher, a first aid kit, and multiple carbon monoxide and smoke detectors are present in the home. LPA found the home's interior to be clean and orderly, with proper heating and ventilation for safety and comfort. Disinfectants, cleaning solutions, poisons, and other hazardous items were in the kitchen cabinets and were inaccessible to children with child safety locks. The bathroom was found to be clean and fully operational. The toilet and handwashing facility were well-kept, safe, and clean.

LPA observed that the daycare areas had age-appropriate toys, furniture, and educational materials. No equipment, such as walkers, bouncers, or similar objects, was present in the home. The fireplace was observed to be properly barricaded. Electrical outlets were observed to be properly covered with child safety covers. According to the licensee, no firearms or weapons are on the premises.

The outdoor area was enclosed by a fence and equipped with safe play equipment for the children to use. No bodies of water, such as pools or spas, were present on site.

According to the licensee, she provides food and snacks for the children. LPA reminded the licensee about the importance of sanitation and proper food preparation. Food and snacks were observed to be available for the children.

The sleeping/resting areas were clean and sanitary. LPA observed cribs, mats, sheets, and blankets in the sleeping/resting areas. LPA also observed that the infant mattress was firm and appropriately covered with a fitted sheet appropriate to the size of the mattress. LPA observed cribs to be free of loose articles and materials.

LPA reviewed five children’s files and confirmed that four children have complete files that include their emergency contact and medical information and sleep logs for children under two years old. LPA reminded the licensee to maintain the forms LIC 9227 and LIC 627 for the children’s files.



See Page 3
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2024
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: ANDRADE-WOLF, ANA
FACILITY NUMBER: 214200004
VISIT DATE: 07/23/2024
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
26
27
28
29
30
31
32
Page 3
LPA reviewed the three staff files and confirmed that all required forms were present. LPA found that the licensee possesses a current Pediatric First Aid/CPR certification, which expires on 3/2026. LPA reviewed the three staff immunization records and found that one staff member did not have their immunization record on file. LPA also reviewed the Mandated Reporter Training for the three staff members and found that one staff member has an expired Mandated Reporter Training certificate. LPA reminded the licensee that Mandated Reporter Training must be taken every two years. Mandated Reporter Training may be taken at www mandatedreporterca.com.

Licensee was reminded that all adults 18 and over living or working in the home, 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.

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: https://www.ada.gov/resources/child-care-centers/.

LPA discussed the safe sleep regulations with licensee 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 licensee 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.

Licensee was informed of the MyChildCarePlan.org website; 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.

See Page 4

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

DATE: 07/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2024
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: ANDRADE-WOLF, ANA
FACILITY NUMBER: 214200004
VISIT DATE: 07/23/2024
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
26
27
28
29
30
31
32
Page 4
During the exit interview, the licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Please refer to LIC 809D for today’s citation.

A copy of today's report and the facility's appeal rights were given to the Licensee, Ana Andrade Wolf

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

Exit interview conducted and report was reviewed with the Licensee, Ana Andrade Wolf.








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

DATE: 07/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2024
LIC809 (FAS) - (06/04)
Page: 5 of 5