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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004032
Report Date: 02/20/2025
Date Signed: 02/20/2025 10:23:14 AM

Document Has Been Signed on 02/20/2025 10:23 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:OUALI, MASSIVAFACILITY NUMBER:
384004032
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 6TOTAL ENROLLED CHILDREN: 6CENSUS: 6DATE:
02/20/2025
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:54 AM
MET WITH:Massiva OualiTIME VISIT/
INSPECTION COMPLETED:
10:50 AM
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On February 20, 2025., Licensing Program Analyst (LPA) Van conducted an unannounced inspection to review the licensee's request to increase her license capacity. LPA met with the licensee, Massiva Ouali. At the time of inspection, the licensee supervised 6 children (3 infants and 3 preschoolers). The infants and a preschooler were napping in the cribs on the second-floor napping room. The Licensee complies with the licensee's capacity and limitations. Days and operations hours are 8:00 AM – 5:00 PM. During the visit, the licensee’s husband came home.

LPA inspected the facility for health and safety hazards. According to the licensee, no changes to the physical plan were previously approved. The childcare areas are the downstairs Living Room, Dining Room, Bathroom 1, and Upstairs Nap Rooms 1 & 2. The Off Limit areas: Upstairs Bedrooms 3 and Bathroom 2. During the inspection of the dining room, it was noted that several areas of the wooden floor had noticeable gaps where the planks met. Some of these gaps measured up to three-quarters of an inch. The LPAs advised the licensee to address these issues and repair the gaps before the large license can be approved.

There is age-appropriate furniture, which is sturdy and in good repair. The facility has no pools, spas, or other bodies of water. The facility has a smoke detector, carbon monoxide detector, fully charged fire extinguishers, and a working telephone. All the cleaning solutions, poisons, and other chemicals that are dangerous to the children are stored and inaccessible to the children.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE: DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/20/2025
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: OUALI, MASSIVA
FACILITY NUMBER: 384004032
VISIT DATE: 02/20/2025
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During the inspection, the LPA reminded the licensee that the kitchen and dining area are part of the approved childcare space and accessible to children. The licensee must cover the stove knobs right after cooking. Additionally, all kitchen cabinets that store cleaning products or sharp objects need childproof locks, which should be secured immediately after use.

The licensee has indicated that the Fire Marshal inspected the premises three weeks prior. However, the licensee is required to address several minor improvements and repairs. The Fire Marshal will conduct a follow-up inspection before granting the necessary fire clearance.

During the inspection, the following was discussed and reviewed with the Licensee:
· Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
· Incidentals 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: http://www.ada.gov/childqanda.htm
· The Licensee was given information regarding PIN 20-24-CCP Safe Sleep Regulation
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025
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: OUALI, MASSIVA
FACILITY NUMBER: 384004032
VISIT DATE: 02/20/2025
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·The Licensee was reminded that 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.
· The Licensee was reminded about Mandated Reporter training available on the CCLD website. All staff hired must complete training every two years. Training can be taken online at www.mandatedreporterca.com. If training is unavailable in the native language, a statement can be written stating exemption until the translation is available.
· The Licensee was reminded about the Provider Information Notices (PINs) on the CCLD website.
· Mandatory Posting Requirements: License, Emergency Disaster Plan, and Notification of Parents Rights Poster.
· The capacity limit of a large license was discussed with the Licensee. The Licensee was reminded that a Helper must be present when operating at a large capacity. In addition, Pediatric FirstAid CPR is required for all helpers.

The licensee, Massiva Ouali has not obtained a signed Property Owner/Landlord Consent form (LIC9149). Without this consent, the licensee understands that, once licensed, they can operate with a maximum capacity of 6 [or 12] children. If property owner/landlord consent is obtained in the future, the applicant is advised that a new Application for a Family Child Care Home License (LIC 279) must be submitted with a change of capacity fee of $25, to increase the capacity and provide care to 8 [or 14] children.

Before a recommendation for an increase in the capacity of a large family childcare home, the licensee must satisfy the following:
- Fire clearance STD 850 form from the fire department.
- The gaps in the wooden floor of the dining room need to be repaired.

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

An exit interview was conducted, and the report was reviewed with the licensee Massiva Oauli.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025
LIC809 (FAS) - (06/04)
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