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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384003034
Report Date: 06/06/2024
Date Signed: 06/06/2024 10:13:01 AM

Document Has Been Signed on 06/06/2024 10:13 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:SAN AGUSTIN, MICHELLE E.FACILITY NUMBER:
384003034
ADMINISTRATOR/
DIRECTOR:
SAN AGUSTIN, MICHELLE E.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 488-3931
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94131
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 11DATE:
06/06/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Michelle San AgustinTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
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On June 6, 2024 at approximately 8:30am, Licensing Program Analyst (LPA) Catrina Quimbo, conducted an unannounced, annual inspection. LPA met with licensee, Michelle San Agustin, and explained the purpose of the visit. Present during LPA's visit included 11 preschool children with 2 teaching staff. Licensee is operating within capacity limits and ratio during LPA's visit.

Licensee lives in the multi-level home with their spouse and minor child. All adults living and/or working in the home have fingerprint clearance on file. Hours of operation are Monday through Friday 8:30am to 3:00pm.

Licensee operates home as a Montessori program. Main entrance to program is through door located on ground level of the home. The DAY CARE AREAS are on the ground level of the home only which includes a large classroom, multi-purpose room (napping and gym room), bathroom #1, and backyard area. The OFF LIMIT AREAS located on the ground level of the home are the kitchen (pass by only) and garage and entire upper two levels of the home. Off limit areas are made inaccessible with child safety gates and/or locked doors. There are stairs in the home and in the backyard that include a child safety gate.

LPA toured day care areas of home with licensee. LPA observed home to be in good repair. There are a variety of Montessori toys, materials and equipment that are in good condition. LPA observed cleaning supplies, solutions and poisons inaccessible behind child safety locked cabinets and/or located in home's high shelves. LPA observed low cabinets without child safety locks to not contain any poisonous materials.

Home is equipped with multiple fire extinguishers, a fully stocked first aid kit and a dual smoke/carbon monoxide detector. Carbon monoxide detector was tested during LPA's visit and was observed to be working.

Bathroom for children's use was observed to be in working condition and equipped with appropriate toileting equipment. LPA did not observe low accessible cabinets in children's bathroom.
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SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE: DATE: 06/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/06/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: SAN AGUSTIN, MICHELLE E.
FACILITY NUMBER: 384003034
VISIT DATE: 06/06/2024
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Children have the opportunity to nap in home. LPA observed sleeping cots to be utilized for napping children. Cots and children's sheets are stored appropriately. LPA observed children's sheets to be stored in individual drawers so they are not touching the other. Licensee does not currently have any infants enrolled in home. Per licensee, children who do not nap are provided a quiet activity.

Backyard is entirely enclosed and fenced. LPA did not observe any pools or bodies of water in the backyard. Backyard is equipped with multiple outdoor toys and equipment that were in good condition. There is a play structure in the backyard that has resilient padding underneath with artificial turf and padding. LPA observed turf to be in good condition. There is a garden in the backyard that includes a fence and gate. Compost bins in backyard include tight fitting lids.

LPA reviewed five random children’s records. LPA observed children's records to be complete with required immunizations and emergency information. LPA reviewed licensee and staffs' files. LPA observed staff files to also be complete with required immunizations and current Mandated Reporter certifications. Licensee's CPR/First Aid certification is current and will expire 11/2024.

Licensee has licensing documentation properly posted and available for review. Licensee also maintains a child care roster that was made available for review. Per licensee, there are no weapons or firearms in the home.

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: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2024
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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: SAN AGUSTIN, MICHELLE E.
FACILITY NUMBER: 384003034
VISIT DATE: 06/06/2024
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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.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514- 0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-carecenters/

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, the licensee, Michelle San Agustin, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

No deficiencies were issued today during LPA's visit.

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

Exit interview conducted and report was reviewed with the licensee, Michelle San Agustin.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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