384001808-7-19-2024-05-CC-LGOZ-D7BVAZ-20240719161648

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384001808
Report Date: 07/19/2024
Date Signed: 07/19/2024 04:16:56 PM

Document Has Been Signed on 07/19/2024 04:16 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:	MONDOY, BERTA A.		FACILITY NUMBER:	384001808
ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 3	DATE:	07/19/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:10 PM
MET WITH:	Berta Mondoy		TIME VISIT/ INSPECTION COMPLETED:	04:25 PM

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On 7/19/2024 at 2:15PM., Licensing Program Analyst (LPA), Luis Gomez met with Licensee, Berta Mondoy. The purpose of today’s visit was explained and was for an unannounced, annual random inspection. Present was the licensee and assistant caring for 3 children. (1 infant-age, 2 preschool-age) All adults have criminal record clearances on file. Per licensee days and hours of operations are Monday- Friday, 8:00AM.- 5:00PM. Areas of the home designated for childcare are: First Level- Playroom (Living Room); Kitchen/Dining Area; Bathroom #1; Bedroom #1; Street Level: Backyard; and Playroom #2. Area of the home designated as off-limit areas are: First Level: Bedroom #2, Bedroom #3 and Street Level- Garage. LPA inspected facility with licensee for health and safety hazards.

At 2:20PM., the following was observed: Facility was clean, neat, with age-appropriate playthings available for the children. The floors and ground surfaces were clear of any obstructions. Off-limit areas have been made inaccessible with installed child safety gates. Accessible furniture, books, and playthings inspected were in proper repair. Licensee has cubbies and storage cubbies of children’s belongings. Kitchen area has tables and chairs, scaled to the appropriate size. The accessible cabinets in kitchen area have safety locks installed. Per licensee hazardous items are stored on the high shelf.

For scheduled nap, LPA observed playpen and mats stored in facility. Play pen inspected were equipped with properly sized mattress.

LPA reminded licensee to ensure no loose items should be inside of infant crib. Advisory Note: Technical Violation (LIC9102TV) was issued.

Bathrooms #1 was observed clean with supplies for hand washing. Home was a comfortable temperature with ventilation and lighting. Home had telephone service; functioning carbon monoxide/ smoke detector; and fire extinguisher: 2A:10BC. (REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2024

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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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: MONDOY, BERTA A.	FACILITY NUMBER: 384001808
	VISIT DATE: 07/19/2024

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(PAGE 2)
LPA inspected the Backyard Area. Areas was completely enclosed with turf installed for added safety. Outside playthings inspected were in good repair. Home did not have any pools; fishpond; jacuzzi; or other bodies of water.

At 3:00PM., LPA reviewed facility records including the children files and personnel files. Personnel Files reviewed contained the: Mandated Reporter Training (AB1207).
LPA reminded licensee staff’s immunization must be stored in facility files.

The children’s files were reviewed and included the: Notification of Parent’s Rights (LIC995); Identification and Emergency Information (LIC700); and Consent for Medical Treatment (LIC627); Affidavit Regarding Liability Insurance (LIC282); Individual Infant Sleeping Plan (LIC9227), for qualifying infant.

Licensee to document napping conditions during each 15 minute review, for infant-age children in care.

Licensee's Mandated Reporter Training (AB1207) course certificate was current and expires: 5/2/2025
Licensee’s Cardiopulmonary Resuscitation/ First Aid Certification (CPR) was current, expiring: 4/2026.
Facility is conducting regular emergency disaster drills, with last drill completed on 4/26/2024, properly logged.

The required forms are posted in facility and include the: Child Care License; Notification of Parent’s Rights (PUB379); and Emergency Disaster Plan (LIC610). (REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2024

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: MONDOY, BERTA A.	FACILITY NUMBER: 384001808
	VISIT DATE: 07/19/2024

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(PAGE 3)
Per licensee, isolation of an ill child is in the kitchen. Per licensee, the program provides daily snacks and lunches for children in care.
Facility 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.

LPA discussed the safe sleep regulations with licensee and the 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.

Facility 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.(REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2024

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: MONDOY, BERTA A.	FACILITY NUMBER: 384001808
	VISIT DATE: 07/19/2024

NARRATIVE

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(PAGE 4)
Based on today's inspection, no deficiencies were observed in areas evaluated according to California Title 22, Div. 12 Chap. 3, Health and Safety, Code of Regulations. Exit interview discussing report was conducted with Licensee, Berta Mondoy. Licensee’s signature of this form acknowledges the receipt of these documents.

During exit interview, licensee confirmed no registered sex offenders are living in the facility, and LPA completed 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: 07/19/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2024

LIC809 (FAS) - (06/04)

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