384002616-3-21-2023-05-CC-MOLN-CQ5P2Z-20230321105646

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384002616
Report Date: 03/21/2023
Date Signed: 03/21/2023 10:56:54 AM

Document Has Been Signed on 03/21/2023 10:56 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:	LEETZ, PETER		FACILITY NUMBER:	384002616
ADMINISTRATOR:	LEETZ, PETER		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 886-5968
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94131
CAPACITY:	14	CENSUS:	DATE:	03/21/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Peter Leetz		TIME COMPLETED:	11:30 AM

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 March 21, 2023 at approximately 9:00am, Licensing Program Analysts (LPAs) Catrina Quimbo and Maria Leon Olguin, conducted an unannounced, annual inspection. LPAs met with licensee, Peter Leetz, and explained the purpose of the inspection. Present during the visit included licensee, licensee's two assistants and 12 enrolled children (3 infants and 9 preschool age). All adults living and/or working in the home have criminal record clearance on file. Hours of operation are Monday to Friday from 8:00am to 5:00pm. The home is a multi-level home that includes three levels. Family child care home operates on the second level (main level) of the home. The DAY CARE AREAS are living room, playroom/nap room, bathroom #1, kitchen, dining area, and backyard area. The OFF-LIMIT AREAS are the entire third level and ground level (garage and in-law unit). All off limit areas are barricaded with child safety locked doors and/or child safety gates. LPAs toured day care areas of home with licensee. LPAs observed home to be in good repair with proper temperature and ventilation. There were a variety of toys and equipment that were in good working condition. LPAs observed cleaning supplies, poisons and other chemicals to be stored inaccessible behind child safety locked cabinets. Living room includes a fire place that is appropriately barricaded. Licensee has licensing documentation properly posted and available for review. Bathroom for children's use was observed to be clean and in proper working condition. Bathroom is equipped with appropriate toileting equipment and appropriate sanitation products. Electrical outlets in playroom/nap room were observed to be properly covered and made inaccessible. Home is equipped with a first aid kit and fully charged fire extinguisher. Per licensee, smoke detector is a dual smoke/carbon monoxide detector. Entire backyard area is enclosed with an at least 4 ft. high fence. LPAs did not observe any pools, spas or bodies of water on the property. Outdoor area is equipped with age appropriate toys and materials. Flooring in backyard is padded with artificial turf. LPAs observed any hazards in backyard area to be made inaccessible. (Continue Report on Page 2...)

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Maria Olguin-Leon	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2023

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: LEETZ, PETER	FACILITY NUMBER: 384002616
	VISIT DATE: 03/21/2023

NARRATIVE

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LPA reviewed five random children's records. Children’s files have a record of emergency identification information on file. Licensee's Pediatric First Aid/CPR will expire 01/2024. Staff present also have proof of current First Aid/ CPR certifications. All staff on site have required immunizations made available for review. Last emergency drill was conducted 01/12/2023. Emergency drills are conducted at least once every six months and are properly logged.

LPA reminded licensee about Mandated Reporter training available www.mandatedreporterca.com. Licensee was reminded Mandated Reporter training must be renewed every 2 years and all staff whom directly work with children must complete training.

Licensee was reminded, 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.

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.

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SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Maria Olguin-Leon	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2023

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: LEETZ, PETER	FACILITY NUMBER: 384002616
	VISIT DATE: 03/21/2023

NARRATIVE

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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 maintain posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee, Peter Leetz

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Maria Olguin-Leon	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2023

LIC809 (FAS) - (06/04)

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