384002465-5-31-2023-05-CC-LGOZ-CSCW2N-20230531165438

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384002465
Report Date: 05/31/2023
Date Signed: 05/31/2023 04:55:41 PM

Document Has Been Signed on 05/31/2023 04:55 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:	BONILLA, LEYLA JOSEFA		FACILITY NUMBER:	384002465
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 4	DATE:	05/31/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Leyla Bonilla		TIME COMPLETED:	05:00 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 5/31/2023 at 2:30PM., Licensing Program Analysts (LPA), Luis J. Gomez met with Licensee, Leyla Bonilla. Purpose of the inspection was explained and was for an Unannounced; Annual Random inspection. Present in facility was the licensee, licensee’s assistant, and four children (three school age, one infant age). Infant-age child, C1, was picked up during inspection. Adults have criminal record clearances on file. Licensee’s home is a one bedroom, one bathroom, one level unit. Days and hours of operations are: Monday- Friday, 7:00AM., to 5:00PM. Daycare areas are: Living room (Playroom), Kitchen, and Bathroom #1. Off Limit areas are: Bedroom #1. LPA inspected facility with licensee for health and safety hazards. At 2:35PM., the following was observed: Facility was clean, orderly, with age-appropriate playthings available for the children. Floor/ ground surface was clear of obstructions. Children furniture, blocks, and books inspected were in good repair. Playroom has child- sized table and chairs for seated activities. For napping services, LPA observed Play pen stored in playroom. Per licensee, infant sheets are washed weekly. The off-limit areas had been made inaccessible. Bathroom #1 was maintained clean with and supplies for hand-washing. Facility was the correct temperature, with adequate ventilation, and lighting. Home had functioning telephone service, smoke/ carbon monoxide combination detector and fire extinguisher; size 2A10:BC. Home does not have any pools, fishponds, jacuzzi, or bodies of water. (REFER TO 809C, FOR CONT)

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2023

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 05/31/2023 04:55 PM - It Cannot Be Edited

Created By: Luis Gomez On 05/31/2023 at 03:47 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: BONILLA, LEYLA JOSEFA	FACILITY NUMBER: 384002465
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/31/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

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
1 2 3 4	At 3:15PM, Based on record review, LPA confirmed staff’s, S1, proof of immunization missing from personnel records. This poses a potential health and safety risk to children in care.
	POC Due Date: 06/09/2023
	Plan of Correction
1 2 3 4	Licensee will submit staff's proof of immunization to the department prior to the due date: 6/9/2023. Proof of correction will be submitted to the department via email.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Ali Zebila

LICENSING EVALUATOR NAME:

Luis Gomez

LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2023

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: BONILLA, LEYLA JOSEFA	FACILITY NUMBER: 384002465
	VISIT DATE: 05/31/2023

NARRATIVE

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(Page 2)
At 3:05PM, LPA reviewed facility and children’s records. Staff records were reviewed and contained: Notice of Employee Rights (LIC9052) and Acknowledgement to Report Suspected Child Abuse (LIC9108).

At 3:15PM, Based on record review, LPA confirmed staff’s, S1, proof of immunization missing from personnel records.

Children’s files were reviewed and included the: Identification of Emergency Information (LIC700) and Immunization Records.

LPA reminded licensee to ensure children's file contain all documents including: LIC995A, LIC610 and LIC282. Advisory Note: Technical Violation (LIC9102TV) was issued.

At 3:25PM., Based on record review, LPA confirmed licensee missing documentation for infant napping condition for each 15-minute review. Advisory Note: Technical Assistance (LIC9102TA) was issued

Licensee’s Cardiopulmonary Resuscitation (CPR)/ First Aid certification was current, expiring: 3/2025.

Licensee’s ‘Mandated Reporter Training’ (AB1207) was current expiring: 8/2024.

Licensee is conducting disaster drills, with last one completed on 2/22/2023, and properly logged.

Required posting are posted, including Childcare License, Notification of Parent’s Rights (PUB379), Emergency Disaster Plan (LIC610A). Per licensee, isolation of an ill children is in the playroom.

Children's Roster has been updated (LIC9040).

LPA advised licensee to ensure all children’s meal containers brought by families must be labeled. Per licensee, home does not have any firearms.

Licensee was reminded all adults, 18 years and over, living or working in the home, including employee and volunteers, 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 up to $500.00 maximum per day/ per person will be assessed if this regulation is violated.

(REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2023

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: BONILLA, LEYLA JOSEFA	FACILITY NUMBER: 384002465
	VISIT DATE: 05/31/2023

NARRATIVE

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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.

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 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, deficiencies were observed in areas evaluated according to California Title 22, Div. 12 Chap. 3 Health and Safety Code of Regulations and cited on 809D. LPA conducted exit interview and discussed appeal right, plan of correction and report with licensee, Leyla Bonilla. Signature of this form acknowledges receipt of these documents.

Notice of Site Visit was provided and must remain posted for 30 days.

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2023

LIC809 (FAS) - (06/04)

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