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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384000735
Report Date: 04/25/2024
Date Signed: 04/25/2024 03:13:13 PM

Document Has Been Signed on 04/25/2024 03:13 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:VANEGAS, MIRIAMFACILITY NUMBER:
384000735
ADMINISTRATOR/
DIRECTOR:		VANEGAS, MIRIAMFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 285-4067
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
04/25/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:05 PM
MET WITH:Miriam VanegasTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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On 4/25/2024 at 1:05PM., Licensing Program Analyst (LPA), Luis Gomez met with Licensee, Miriam Vanegas. The purpose of today’s inspection was explained and was for an unannounced/ random Inspection. Present was the licensee caring for 4 children (3 infant-age, 1 preschool age). Adults present have criminal record clearances on file. Per licensee, child care's days and hours of operations are Monday- Friday, 8:00AM- 5:00PM. Areas of the home used for care are: Living room (Playroom#1, #2) and Bathroom #1. Area of the home designated as off-limit include: Bedroom #1; Bedroom #2; Bathroom #2; and Kitchen (Pass through only). LPA inspected home for health and safety hazards.

At 1:15PM., LPA observed the following: Facility was clean, orderly with playthings available for the children. The floors and ground surfaces were clear of obstructions or hazards. The children’s furniture, learning materials, and books were in like-new condition. Fireplace in playroom #1 had been properly barricaded. LPA observed tables and chairs, scaled to the proper size. Off-limit areas had been made inaccessible with child safety gates

For napping services, LPA observed playpens and several mats. Play pen inspected was equipped with a mattress and tight fitted sheet. Per licensee, play pen is available for each infant in care. Per licensee, the napping linens are washed weekly. Bathroom #1 was maintained clean with fixtures in operating condition. Facility was equipped with diaper changing tables. Per licensee area is disinfected after each use. Licensee's home was a comfortable temperature, with ventilation and lighting. Home had functioning telephone service; carbon monoxide /smoke combination detector; and fire extinguisher: 2A:10:BC, with a full charge.

Home does not have any pools, fishponds, jacuzzi or bodies of water. Per licensee, for outside play she takes children to the local playground. (REFER TO 809C, FOR CONT)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 04/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/25/2024
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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: VANEGAS, MIRIAM
FACILITY NUMBER: 384000735
VISIT DATE: 04/25/2024
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At 1:45PM., LPA reviewed facility records including the children’s files.
Children’s files were reviewed and included the: Identification and Emergency Information (LIC700); Notification of Parent’s Rights (LIC995); Immunization Records; and Notice of Additional Children (LIC9150).

Licensee is documenting infant napping conditions, logging each 15 minute review.

Licensees ‘Mandated Reporter Training' (AB1207) certification was current, expiring on 12/2025.
Licensees Cardiopulmonary Resuscitation/ First Aid Certification (CPR) was current, expiring on 6/2024.

Per licensee, emergency disaster drill was completed on 4/15/2024. Disaster drill had been properly logged by operator.

The required forms are posted in hallway including the Facility License; Notification of Parent’s Rights (PUB379); and Emergency Disaster Plan (LIC610A).

Per licensee, isolation of an ill child is in the playroom. Per licensee, she provides breakfast and lunch services for children.

Licensee was reminded that all adults 18 years and over living in the home, person who provides care and supervision to children, and staff who have contact with children, including employee and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain criminal 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. (REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2024
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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: VANEGAS, MIRIAM
FACILITY NUMBER: 384000735
VISIT DATE: 04/25/2024
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LPA discussed the safe sleep regulations with licensee and discussed Child Care Licensing Safe Sleep Web page at:https://www.cdss.ca.gov/inforesource/child-care-licesning/public-information-and-resources/safe-sleep as an additional resource. LPA informed licensee of the importance of checking for recalled infant devices on United States consumer Product Safety Commission (CPSC) website at http://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 www.mychildcareplan.org site is a consumer education website that helps families obtain child care by connecting to child care providers and resources and referral agencies (R&R) throughout California.

Incidental Medical Services (IMS) policy was discussed. For IMS information, see PIN 20-02-CCP. When an IMS is provided, a plan for 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- 0382 (TTY) and link to publications: Commonly asked questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

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 tool, please send them 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/inforesource/community-care-licensing/inspection-process.

Based on today's inspection, no deficiencies were cited in areas evaluated according to California Title 22, Div. 12 Chap. 3, Health and Safety, Code of Regulations. Exit interview was conducted and report was reviewed with Licensee, Miriam Vanegas. Licensee’s signature of this form acknowledges the receipt of these documents.



During exit interview, Licensee, Miriam Vanegas confirmed there are no registered sex offenders living in the facility, and LPA completed the RSO profile. Notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2024
LIC809 (FAS) - (06/04)
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