384003071-2-8-2024-05-CC-LGOZ-D2A33S-20240208165401

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384003071
Report Date: 02/08/2024
Date Signed: 02/08/2024 04:54:12 PM

Document Has Been Signed on 02/08/2024 04:54 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:	GARCIA, SANDRA P.		FACILITY NUMBER:	384003071
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 2	DATE:	02/08/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	02:55 PM
MET WITH:	Sandra Garcia		TIME COMPLETED:	05:00 PM

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 2/8/2024 at 2:55PM., Licensing Program Analysts (LPA), Luis Gomez met with Licensee, Sandra Garcia. The purpose of inspection was explained and was for an Unannounced, Annual Random Inspection. Present was the licensee caring for 2 children. (1 preschool age, 1 infant age). Licensee’s home is a one bedroom, one bathroom, one level apartment. Licensee’s days and hours of operation are: Monday- Friday: 8:00am- 5:00pm. The areas used for childcare are: Living Room (Playroom); Hallway; and Bathroom #1. The off-limit areas are Bedroom #1 and Kitchen. LPA inspected licensee’s home for health and safety hazards.

At 3:00PM., the following was observed: Facility was clean and orderly with age-appropriate playthings available for the children. The floor/ ground surfaces were clear of obstructions. Accessible furniture, toys, and books inspected were in like-new condition. Labelled baskets and hangers were available for children’s belongings. The playroom has child sized tables and feeding several chairs for food services. Per licensee, table is folded and put away when not in use. For nap services, LPA observed infant playpens with mattress and tight-fitting sheets. LPA observed crib/ play pen for each infant in care. License’s bathroom was maintained clean with supplies for hand washing. Bathroom cabinets had safety locks installed. Facility was a comfortable temperature with adequate ventilation and lighting. The facility’s poisons, detergents, cleaning compounds, medicines, and other items which could pose a danger if readily available, had been made inaccessible to children in care. Facility had functioning telephone service; smoke detector; and fire extinguisher: 2A:10:BC in kitchen.

LPA reminded licensee to ensure functioning carbon monoxide detector is installed in facility. Advisory Note: Technical Violation (LIC9102TV) was issued.

Home does not have any pool, fishponds, jacuzzies or bodies of water.

(REFER TO 809c, FOR CONT)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024

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 4

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: GARCIA, SANDRA P.	FACILITY NUMBER: 384003071
	VISIT DATE: 02/08/2024

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
26
27
28
29
30
31
32

(Page 2)
At 3:30PM., LPA reviewed facility records including the children’s files. Files were reviewed and included the children’s Immunization Records; Identification and Emergency Information (LIC700); Consent for Medical Treatment (LIC627); and Notification of Parent's Rights (LIC995). The licensee is documenting licensee infant napping conditions during each 15 minute review.

Licensee ‘Mandated Reporter Training’ certification was current and expiring: 7/4/2024.
Licensee is conducted required emergency disaster drill in the last six months, with last drill completed on: 1/10/2024, properly logged.
Licensee’s 'Cardiopulmonary Resuscitation/ First Aid’ (CPR) certification was current and expires: 1/2026.

Required forms were observed posted including the: License and Notification of Parent’s Rights (PUB379).

Per licensee, isolation of an ill child is in the Living Room. Per licensee, she provides all food service for children in care.

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.

LPA discussed the safe sleep regulations with licensee and discussed 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.

Licensee 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. (REFER TO 812c, FOR CONT.)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: GARCIA, SANDRA P.	FACILITY NUMBER: 384003071
	VISIT DATE: 02/08/2024

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
26
27
28
29
30
31
32

(Page 3)
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 and facility evaluation report was reviewed with Licensee, Sandra Garcia. Licensee’s signature of this form acknowledges the receipt of these documents.

During exit interview, licensee, Sandra Garcia confirmed that there are no registered sex offenders living in the facility, and LPA completed the 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: 02/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024

LIC809 (FAS) - (06/04)

Page: 4 of 4