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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214200169
Report Date: 10/02/2024
Date Signed: 10/02/2024 10:53:34 AM

Document Has Been Signed on 10/02/2024 10:53 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:RUSHWORTH, TERIFACILITY NUMBER:
214200169
ADMINISTRATOR/
DIRECTOR:		RUSHWORTH, TERIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 456-1948
CITY:SAN ANSELMOSTATE: CAZIP CODE:
94960
CAPACITY: 14TOTAL ENROLLED CHILDREN: 6CENSUS: 6DATE:
10/02/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:02 AM
MET WITH:Teri RushworthTIME VISIT/
INSPECTION COMPLETED:
11:05 AM
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 10/2/2024, Licensing Program Analyst (LPA) Hanson Leong conducted an unannounced annual visit and met with the Licensee, Teri Rushworth. LPA explained the purpose of the visit to the licensee.

During the visit, six children (two infants and four pre-k) and three adults (the licensee, the licensee’s husband, and an enrolled child’s grandfather) were present. The licensee and the licensee’s husband received criminal record clearance from the department. A grandparent of a child in the facility is exempt from submitting fingerprints to the department. A dog was present in the home. The licensee holds a large license and is within capacity limits and ratios for today’s visit.

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 8/1/2024, and the LPA observed that it was properly documented. LPA reviewed the emergency disaster drill log and found they were conducted at least once every six months.

Day-care Areas: Garage (Playroom), Bedroom #1, Bathroom #2, and Backyard.

Off-Limit Areas: Kitchen (Pass-through only), Living room, and Bedroom #3.

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

See Page 2

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE: DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/02/2024
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 3
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: RUSHWORTH, TERI
FACILITY NUMBER: 214200169
VISIT DATE: 10/02/2024
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 observed that the daycare areas had age-appropriate toys, furniture, and educational materials. The home had permanent or portable storage space for the children’s clothing and personal belongings. According to the licensee, no firearms or weapons are on the premises.

The backyard is enclosed by a fence and equipped with outdoor play equipment that is in good condition. LPA did not observe any pools, spas, or bodies of water on site.



The licensee does not currently provide food service for the children. The children's parents or guardians must provide lunches and snacks for their children. Per the licensee, no children enrolled currently have any allergies.

Napping mats and a playpen are available for the children to rest or nap. The playpen is free of loose articles and materials.

LPA reviewed five children’s files and confirmed that all five have complete files, including their emergency contact information, medical information, and records of the children’s 15-minute sleep checks.

LPA reviewed the licensee’s file and confirmed that all required forms were present. LPA found that the licensee possesses a current Pediatric First Aid/CPR certification, which expires on 9/2026.

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/.

See Page 3

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

DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: RUSHWORTH, TERI
FACILITY NUMBER: 214200169
VISIT DATE: 10/02/2024
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 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.

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.

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, Teri Rushworth.

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

DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2024
LIC809 (FAS) - (06/04)
Page: 3 of 3