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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001202
Report Date: 04/12/2023
Date Signed: 04/12/2023 05:09:03 PM

Document Has Been Signed on 04/12/2023 05:09 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:PETROVA, TETJANAFACILITY NUMBER:
384001202
ADMINISTRATOR:PETROVA, TETJANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 242-5115
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94116
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
04/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Tetjana PetrovaTIME COMPLETED:
05:15 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 April 12, 2023., Licensing Program Analyst (LPA) Van performed an annual 1-year mandatory inspection, which included checking the interior and exterior of the facility and discussing the required childcare paperwork with the Licensee. The purpose of the inspection was explained, and granted entry to the home by the Licensee. Nine children were in care with the Licensee and her helper (3 infants and 6 preschoolers). The Licensee complied with her license capacity and limitation. All adults resident or employees have criminal record clearance on file. The Days and operation hours are 7:00 am – 6:00 pm, Monday – Friday.
Childcare areas are on the street floor level, including the playroom, nap room, backyard, full bathroom, and half bathroom. The off-limit areas are the entire 2nd floor and the garage. LPA reviewed and inspected the Licensee's home for health and safety hazards. The daycare area is clean, orderly and has safe, age-appropriate toys, books, and play equipment. The home has adequate heating, lighting, and ventilation and is free from defects or conditions that endanger children in care. The home has a fully charged fire extinguisher, smoke and carbon monoxide detectors, and a working telephone. Fully stocked first aid supplies are available for children. No pools, spas, or bodies of water on the premises.
LPA reminded the Licensee that no toys, pillows, or objects should be hanging above the cribs/playpens per Infant Safe Sleep Regulation. All mattresses shall be designed for that cribs, and bedsheets should be tight-fitted.
The Licensee serves all breakfast, lunch, and morning and afternoon snacks. The Licensee stated the fire and drills are conducted once every six months, and the last drills were conducted on 2/8/2023.
Continued on page 2...
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE: DATE: 04/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/12/2023
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: PETROVA, TETJANA
FACILITY NUMBER: 384001202
VISIT DATE: 04/12/2023
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
 LPA reviewed all of the children's records during the inspection. The Licensee maintains thorough records for all children, including vaccination records and Parent's Rights forms. LPA confirmed that each child has 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 Licensee and her helper maintained proper immunization records. All Mandated Reporter Training and Pediatric First Aid are valid. The facility also has up-to-date Child Care liability insurance.
All mandatory postings (License/Parent's Rights poster/Emergency Disaster Plan and Earthquake Preparedness Checklist) are posted.
During the inspection, the following was reviewed and provided to the Licensee.
  • LPA discussed care and supervision with the Licensee. The Licensee acknowledges that care cannot be provided over the capacity specified on the license.
  • The Licensee was reminded that as of September 1, 2016, all Staff and Volunteers must provide proof of immunization against pertussis, measles, and influenza or qualifies for an exemption, pursuant to Health and Safety code 1596.7995 and 1597.622.
  • The Licensee was reminded about the Provider Information Notices (PINs) on the CCLD website.
  • 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.
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 the 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.
Continued on page 3...
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2023
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: PETROVA, TETJANA
FACILITY NUMBER: 384001202
VISIT DATE: 04/12/2023
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
 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.
LPA discussed the safe sleep regulations with Licensee and the Child Care Licensing Safe Sleep webpage at 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.
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.
No deficiencies were cited in today's inspection. The Licensee read and signed the report. The annual report and site visit notice were provided to the Licensee. LPA reminded the Licensee 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. For additional questions, the Licensee was advised to contact the CCLD office, Monday to Friday, 8:00 am - 5:00 pm, (650) 266-8800 or 1 (844) 538-8766. Website: www.cdss.ca.gov.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3