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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384003070
Report Date: 08/08/2024
Date Signed: 08/08/2024 12:03:32 PM

Document Has Been Signed on 08/08/2024 12:03 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:ROSILLO, ANGELINA A.FACILITY NUMBER:
384003070
ADMINISTRATOR/
DIRECTOR:		ROSILLO, ANGELINA A.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 418-8563
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
08/08/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Angelina Rosillo TIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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On 8/8/2024 at 8:30AM., Licensing Program Analyst (LPA), Luis Gomez met with Licensee, Angelina Rosillo. The purpose of today’s visit was explained and was for an unannounced, annual/ random inspection. Present was the licensee and 2 assistants caring for 9 children. (3 infant-age, 6 preschool age) Adults have criminal record clearances on file. Licensee home is a 2 bedroom, 2 bathroom, 2 level house. Per licensee days and hours of operations are Monday- Friday, 8:00AM.- 5:30PM. Areas of the home designated for childcare are: Lower Level: Living Room (Play Room #1); Family Room (Play Room #2); Bedroom #1 (Napping Only); Bathroom #1; Dining Area; and Backyard. Areas of the home designated as off-limit areas are: Lower Level: Kitchen (Pass through only), Entire Upper Level: Bedroom #2; Bedroom #3; and Bathroom #2. LPA inspected facility for health and safety hazards.

At 8:45AM., the following was observed: Facility was clean and neat, with age-appropriate playthings and materials available for the children. Floors and ground surfaces were clear of any obstructions or hazards. Facility has several child safety gates preventing access to the off-limit areas. Accessible furniture, puzzles, and materials inspected were in proper repair. Licensee has storage cubbies for children’s belongings. For food services, LPA observed several tables and chairs, scaled to the appropriate size. For napping services, LPA observed play yard and mats stored in bedroom #1. Play yards were equipped with correctly sized mattress and sheets. Per licensee, napping sheets are washed weekly.

At 9:25AM., Based on observation, LPA confirmed door was closed to bedroom #1, with napping infant. Advisory note: Technical Violation (LIC9102TV) was issued.

Bathroom #1 was observed clean with supplies for hand washing. Home was a comfortable temperature with adequate ventilation and lighting. Home had telephone service; carbon monoxide detector; smoke detector; and fire extinguisher (2A:10BC). The detergents, cleaning compound, and toxins have been stored in the off-limit areas. (REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 08/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/08/2024
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 6
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: ROSILLO, ANGELINA A.
FACILITY NUMBER: 384003070
VISIT DATE: 08/08/2024
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LPA inspected the backyard area. Area was enclosed, with absorbent padding material installed for added safety. Home did not have any pools; fishpond; jacuzzi; or other bodies of water. Per licensee, for outside play children are also taken to local park (Bernal Park).

LPA reviewed facility records including the children and personnel files. The children’s files were reviewed and included the: Identification and Emergency Information (LIC700); Individual Infant Sleeping Plan (LIC9227); and Immunization Records.



Licensee is maintaining logs to document each 15 minute review for napping infants in care.

The staff files were reviewed and included the: Notification of Employee Rights (LIC9052) and Acknowledgement to Report Suspected Child Abuse (LIC9108).

LPA reminded licensee to ensure the staff's proof of completed mandated reporter training course (ab1207), and immunization records are stored in facility records. Advisory Note: Technical Violations (LIC9102TV) were issued.

Licensee’s Cardiopulmonary Resuscitation/ First Aid Certification (CPR) was current, expiring: 2/2025.
Per licensee, facility is conducting regular emergency disaster drills, with last drill logged and dated: 2/16/2024.

The required forms are posted in facility and include the: Child Care License; Notification of Parent’s Rights (PUB379); and Emergency Disaster Plan (LIC610).

Per licensee, isolation of an ill child is in the dining area. Per licensee, facility provides daily food services for children in care. Children’s medication was reviewed during inspection.



Licensee was reminded that all adults 18 years and over living in the home, person who provides care and supervision to children, and staff who have contact with children, including employee and volunteers, except as specified in Health and Safety Code section 1596.871, 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 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. (REFER TO 809C, FOR CONT.)
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2024
LIC809 (FAS) - (06/04)
Page: 4 of 6
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: ROSILLO, ANGELINA A.
FACILITY NUMBER: 384003070
VISIT DATE: 08/08/2024
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LPA discussed safe sleep regulations with licensee and the 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.

Facility was informed of the www.mychildcareplan.org site is a consumer education website that helps families obtain child care by connecting to child care providers and resources and referral agencies (R&R) throughout California.

Incidental Medical Services (IMS) policy was discussed. For IMS information, see PIN 20-02-CCP. When an IMS is provided, a plan for 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- 0382 (TTY) and link to publications: Commonly asked questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

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 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, no deficiencies were cited in areas evaluated according to California Title 22, Div. 12 Chap. 3, Health and Safety, Code of Regulations. Exit interview discussing facility evaluation report was completed with Licensee, Angelina Rosillo. Licensee’s signature of this form acknowledges the receipt of these documents.



During exit interview, licensee confirmed no registered sex offenders are living in the facility, and LPA completed RSO profile. Notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2024
LIC809 (FAS) - (06/04)
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