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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002612
Report Date: 03/16/2023
Date Signed: 03/16/2023 09:47:17 AM

Document Has Been Signed on 03/16/2023 09:47 AM - 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:RIVAS, SAMARYFACILITY NUMBER:
384002612
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 6CENSUS: 6DATE:
03/16/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Samary RivasTIME COMPLETED:
10:00 AM
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On March 16, 2023 at approximately 8:20am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, annual inspection. LPA met with licensee, Samary Rivas, and explained the purpose of the inspection. Present during LPA's visit included licensee, licensee's spouse, licensee's mother, licensee's two minor children (school age), and 5 enrolled children (2 infants and 3 preschool age). Licensee is operating within capacity limits and ratio during LPA's visit. All adults in the home have fingerprint clearance on file.

Hours of operation are Monday to Friday 8:00am to 5:00pm. The home is a multi-level home that consists of three levels. The DAY CARE AREAS are located on the second level of the home only that includes the living room/kitchen area (main play room), bathroom #1, and outdoor/patio area. The OFF LIMIT AREAS are the garage (ground level), family room (second level), dining area (second level), and entire third level of the home.

At approximately 9:00am, licensee's minor children left facility. LPA inspected the day care areas for health and safety hazards. Home operates as a Spanish immersion program. There are stairs in the home that are properly barricaded from day care children.

LPA observed home to be in good repair with proper temperature and ventilation. LPA did not observe any electrical outlets in day care area. Home is equipped with a variety of age appropriate toys and equipment. Cleaning supplies, poisons and other chemicals were stored inaccessible to children in home's high shelves.

Home is equipped with a working carbon monoxide detector, fully charged fire extinguisher, fully stocked first aid kit, and a working phone on site. Phone number listed for licensee is current. Per licensee, there are no weapons, firearms or pets in the home.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE: DATE: 03/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/16/2023
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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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: RIVAS, SAMARY
FACILITY NUMBER: 384002612
VISIT DATE: 03/16/2023
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At approximately 9:20am, additional infant arrived to facility. Present during LPA's visit included 6 children (3 infants and 3 preschool age). Licensee continues to operate within capacity limits and ratio during LPA's visit.

LPA did not observe any pools, spas or bodies of water on the property. Outdoor patio area is enclosed with an at least 5 ft. high fence. Outdoor area was observed to be clean, free of any loose articles or debris.

LPA reviewed all 6 children's records, whom were present during the inspection, which were complete. Children's files have a record of emergency identification information on file and required immunizations available for review. Licensee's CPR certification is current and will expire 09/2023. Licensee's Mandated Reporter certification is also current and will expire 03/2024.

Last emergency disaster drill was conducted 01/09/2023. Emergency drills are conducted at least once every six months and are properly logged.

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.

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

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: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2023
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: RIVAS, SAMARY
FACILITY NUMBER: 384002612
VISIT DATE: 03/16/2023
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LPA discussed the safe sleep regulations with licensee and discussed 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 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.

No deficiencies were cited today under CCR, Title 22, Div. 12.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee, Samary Rivas.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2023
LIC809 (FAS) - (06/04)
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