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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380506534
Report Date: 03/24/2023
Date Signed: 03/24/2023 03:55:56 PM

Document Has Been Signed on 03/24/2023 03:55 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:SULLIVAN, PATRICIAFACILITY NUMBER:
380506534
ADMINISTRATOR:SULLIVAN, PATRICIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 661-6124
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94132
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
03/24/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Patricia SullivanTIME COMPLETED:
04:00 PM
NARRATIVE
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 On March 24, 2023., Licensing Program Analyst (LPA) Van conducted an unannounced annual inspection which included checking the interior and exterior of the facility and discussing the required childcare paperwork with the Licensee. Licensee Patricia Sullian, three helpers, and a behavior technician supervised 11 children today (2 infants and 9 preschoolers). Every adult living or working in the house has a criminal record clearance. The daycare operates from 7:00 am -6:00 pm, Monday through Friday. Childcare Areas are on the lower level only, including the Living room/playroom, kitchen, half bathroom, and backyard. Off-Limit Areas are the Entire upper level of the home. Per Licensee, when a child shows signs of illness, the Licensee will separate and have the child wait in the sunroom while contacting the parent to pick them up. The Licensee has valid childcare liability insurance on file.
LPA and the Licensee toured the childcare areas for health and safety hazards. The home childcare areas are clean and orderly. LPA observed age-appropriate toys and equipment present at home. The house has sufficient lighting and ventilation. A functional telephone, multiple working smokes and carbon monoxide detectors, and a fully charged 2A10BC fire extinguisher are all in the house. LPA discussed the new Safe Sleep Regulation with the Licensee and informed the Licensee that there should be no toys or pillows inside the baby cribs/playpens and no objects hanging above them. LPA also discussed with the Licensee that all mattresses/padding should be designed for the particular cribs/playpens, and bedsheets should be tight-fitted. In addition, the Licensee was informed to physically check on the infant every 15 minutes during naptime and document them. The Licensee understood that no baby walkers, bouncers, exersaucers, or other similar items are permissible to be used during daycare hours.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE: DATE: 03/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/24/2023
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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Document Has Been Signed on 03/24/2023 03:55 PM - It Cannot Be Edited


Created By: Brendon Van On 03/24/2023 at 02:33 PM
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: SULLIVAN, PATRICIA
FACILITY NUMBER: 380506534

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/24/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on the interview and record review, the Licensee did not comply with the section cited above; two out of four staff members did not have proper Mandated Reporter training or could not provide any record of completion available for review, which poses/posed a potential health, safety, or personal rights risk to persons in care.
POC Due Date: 04/07/2023
Plan of Correction
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The Licensee must ensure that the Mandated Reporter Training is completed bi-annually and available for review during the inspection for all staff. The Licensee states she will have the staff complete the training on or before April 7, 2023, and submit it to LPA.
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
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Based on the record review, the Licensee did not comply with the section cited above. The Licensee did not have immunization records of Measles and pertussis on file or records available for review, which poses/posed a potential health, safety, or personal rights risk for persons in care.
POC Due Date: 04/07/2023
Plan of Correction
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The Licensee must ensure that all personnel's immunization records are on file and available for review. The Licensee states she will have her immunization records submitted to LPA on or before April 7, 2023.
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:Garfield Leung
LICENSING EVALUATOR NAME:Brendon Van
LICENSING EVALUATOR SIGNATURE:
DATE: 03/24/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/24/2023


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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: SULLIVAN, PATRICIA
FACILITY NUMBER: 380506534
VISIT DATE: 03/24/2023
NARRATIVE
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 According to the Licensee, no bodies of water are on the premises. Daycare children have no access to detergents, disinfectants, or cleaning chemicals. The Licensee stated there are no guns or weapons in the house.
The Licensee maintains records for all children in her care, including vaccination records and Parental Rights forms. Each child had a complete emergency information card with the child's full name, phone number, and the location of a parent or authorized person who may be called in an emergency. The emergency drills are held at least once every six months, and each drill is appropriately logged/documented by the Licensee. The facility children's roster has been reviewed and found to be complete and current. License capacity and limitation options were reviewed, and the Licensee acknowledges that care cannot be provided over the capacity specified on the license. The requirements for reporting suspected child abuse, as well as reporting requirements for unusual incidents, were discussed. All mandatory postings (License/Parent's Rights poster/Emergency Disaster Plan and Earthquake Preparedness Checklist) are posted.
Staff records review revealed that several staff members were missing the mandated reporter training or did not have the certificate available for review. In addition, the Licensee immunization record was missing measles and pertussis.
The Licensee was reminded that all adults 18 and over living or working in the home, 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.
The Licensee was reminded that all adults 18 and over living or working in the home, 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.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2023
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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: SULLIVAN, PATRICIA
FACILITY NUMBER: 380506534
VISIT DATE: 03/24/2023
NARRATIVE
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 LPA discussed the safe sleep regulations with the Licensees and discussed the Child Care Licensing Safe Sleep webpage https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed the 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.
The incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: www.ada.gov/childqanda.htm.
Licensees were informed that as of September 1, 2016, a person may not be employed or volunteer at a childcare facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.
LPA reviewed AB 1207 with the Licensees. As of January 1, 2018, all staff must complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.
To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2023
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: SULLIVAN, PATRICIA
FACILITY NUMBER: 380506534
VISIT DATE: 03/24/2023
NARRATIVE
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During the inspection, LPA requested that the Licensee's following documents be sent to Licensing to complete the annual inspection.
-Licensee updated immunization record
-Mandated reporter training for two staff members.

See LIC 809D for deficiencies cited today.

Licensee Patricia Sullivan read and signed the report. Today's report, deficiencies, appeal rights and site visit notice were provided to the Licensee. LPA informed the Licensee that a site visit notification must be posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2023
LIC809 (FAS) - (06/04)
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