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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002713
Report Date: 07/12/2024
Date Signed: 07/12/2024 11:23:14 AM

Document Has Been Signed on 07/12/2024 11:23 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:MATSUI, DANIELAFACILITY NUMBER:
384002713
ADMINISTRATOR/
DIRECTOR:		MATSUI, DANIELAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 756-8000
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94117
CAPACITY: 14TOTAL ENROLLED CHILDREN: 6CENSUS: 6DATE:
07/12/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:55 AM
MET WITH:Licensee, Daniela MatsuiTIME VISIT/
INSPECTION COMPLETED:
11:35 AM
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On 7/12/2024, at approximately 8:55AM, Licensing Program Analyst (LPA) Jonathan Tse conducted an unannounced annual visit at the facility. LPA met with Licensee, Daniela Matsui, and explained the purpose of the visit. Present during the visit was Licensee, a minor over the age of 10, three preschool age children, and three infants. The facility’s operating hours are from 8:30AM to 5:00PM.

Daycare Areas: Play Room, Bedroom #1, Bedroom #2, Kitchen, and Bathroom.
Off-limits Areas: Living Room, Porch, and Backyard.

LPA inspected the home for any health or safety hazards. The home is equipped with a fully charged 2A10BC fire extinguisher. There is an operational carbon monoxide detector present in the home. Poisons, cleaning detergents, and other chemicals are stored inaccessible to children. Shelves and cabinets are secured with childproof locks as necessary. Electrical outlets are covered or obstructed by furniture when not in use to be inaccessible to children in care. There is a fireplace in the Play Room that has been covered to be inaccessible to children in care.

LPA observed there to be age-appropriate toys and learning materials in the Play Room. Furniture is age-appropriate and free of rough or sharp edges. Per Licensee, children nap using pack-and-plays. LPA advised that cribs used for sleeping infants shall not contain any loose objects or articles, and that Licensee should not have any objects hanging over, or on the side of, a crib. Licensee stated that they understood. Per Licensee, children bring their own lunch and snacks from home. The facility has extra food in case children do not bring their own. There is a first aid kit present in the Play Room that is fully equipped.



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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE: DATE: 07/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/12/2024
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: MATSUI, DANIELA
FACILITY NUMBER: 384002713
VISIT DATE: 07/12/2024
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There is no outdoor play area for children in the facility. Per Licensee, children are taken to Duboce Park, which is in walking distance of the facility, for outdoor activities and play. There are no swimming pools or other similar bodies of water present in the facility. Per Licensee, there are no firearms or weapons stored in the facility.

LPA reviewed Licensee’s records, five children’s files, and facility records. Licensee’s Pediatric First Aid/CPR is current and expires 12/2024. Licensee’s Mandated Reporter Training is current and expires 8/2025. LPA observed all children’s files to contain Emergency Identification and Information (LIC700) and Consent for Emergency Medical Treatment (LIC627). LPA advised that all files should contain the Notification of Parents’ Rights (LIC995A). Licensee stated that they understood. LPA observed all required postings to be posted in the Play Room. The last emergency drill was conducted in 1/2024. LPA advised that the facility is due for another drill this month. Licensee stated that they understood. Technical assistance was offered today regarding safe sleep regulations and infant and preschool ages.

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 CARE tools, please send email inquiries 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/inspection-process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 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.





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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2024
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: MATSUI, DANIELA
FACILITY NUMBER: 384002713
VISIT DATE: 07/12/2024
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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-andresources/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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

No deficiencies were cited during today’s visit on 7/12/2024. See LIC9102-TV for technical violation issued today regarding the Notification of Parents’ Rights. See LIC9102-TA for technical assistance provided today regarding safe sleep and infant/preschool ages.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Daniela Matsui.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2024
LIC809 (FAS) - (06/04)
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