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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004090
Report Date: 06/29/2023
Date Signed: 06/29/2023 12:26:06 PM

Document Has Been Signed on 06/29/2023 12:26 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:LAMA, NADIA V.FACILITY NUMBER:
384004090
ADMINISTRATOR:LAMA, NADIA V.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 286-4319
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
06/29/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Nadia Lama TIME COMPLETED:
11:30 PM
NARRATIVE
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On 6/29/2023 at 8:45AM., Licensing Program Analysts (LPA), Luis J. Gomez met with Licensee, Nadia Lama. Purpose of the inspection was explained and was for an Unannounced; Annual Random inspection. Present in facility was the licensee caring for three children (1 preschool age, 2 infant age). Adults have criminal record clearances on file. Licensee’s home is a three bedroom, two bathroom, two level house. Days and hours of operation are Mon- Fri, 8:00AM- 5:00PM. Day-care Areas: Top Level Bedroom #1, Bathroom #1, Living Room Area (Playroom), and Ground level: Backyard Area. Off-limit Area: Top Level: Kitchen, Bedroom #2, Living Room #2, Middle Level: Bedroom #3 (Pass through only), Bathroom #2 and Ground level: Garage. LPA inspected facility, indoor and outdoors, with licensee for health and safety hazards.

At 8:50AM., the following was observed: Facility was clean, orderly, with age-appropriate playthings available for the children. Floors/ground surfaces were clear of obstructions or possible hazards. Accessible furniture, blocks and books inspected were in good repair. Cubbies are available in playroom for storage of children belongings. Child sized table and chairs are available for snack and seated activities. For napping services, LPA observed play pens (with tight-fitting sheet) stored in bedroom #1. One crib/ play pen is available for each infant in care. Per licensee, napping sheets are washed every week. The off-limit areas have been made inaccessible, with child safety gates. Bathroom #1 had adequate supplies for hand washing. Facility was the proper temperature, adequate ventilation, and lighting. Facility had functioning cell phone service, smoke/ carbon monoxide combination detector and fire extinguisher, fully charged; size 2A10:BC, located in hallway.

At 9:10AM., LPA inspected facility outdoor play area. Area was enclosed, with playthings in good repair. Area is free of any hazardous plants. Home does not have any pools, fishponds, jacuzzi, or bodies of water. (REFER TO 809C, FOR CONT)
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 06/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/29/2023
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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Document Has Been Signed on 06/29/2023 12:26 PM - It Cannot Be Edited


Created By: Luis Gomez On 06/29/2023 at 10:22 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: LAMA, NADIA V.
FACILITY NUMBER: 384004090

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/29/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.1(a)(6)
Personnel Records
(a) Personnel records shall be maintained on each employee and shall contain the following information: (6) Documentation of completion of training on preventative health practices as required by Section 102416(c).

This requirement is not met as evidenced by:
Deficient Practice Statement
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At 10:10AM., Based on record review, LPA confirmed licensee CPR/ 1st aid certification has expired. This poses a potential health and safety risk to children in care.
POC Due Date: 07/14/2023
Plan of Correction
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Licensee will update CPR/1st aid certification by the due date: 7/14/2023. Proof of correction will be submitted to the department via email.
Type B
Section Cited
CCR
102418(a)
Immunizations
(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000.

This requirement is not met as evidenced by:
Deficient Practice Statement
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At 10:05AM., Based on record review, LPA confirmed licensee missing children’s files C2, C3, from facility files. This poses a potential health and safety risk to children in care.
POC Due Date: 07/14/2023
Plan of Correction
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Licensee will ensure children's files are stored in facility records by the due date: 7/14/2023. Proof of correction will be submitted to the department via email.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Ali Zebila
LICENSING EVALUATOR NAME:Luis Gomez
LICENSING EVALUATOR SIGNATURE:
DATE: 06/29/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/29/2023


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: LAMA, NADIA V.
FACILITY NUMBER: 384004090
VISIT DATE: 06/29/2023
NARRATIVE
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(Page 2)
At 9:45AM, LPA reviewed facility and children’s’ records.

At 10:05AM., Based on record review, LPA confirmed licensee missing children’s files C2, C3, from facility files.

LPA reminded licensee to renew required Mandated Reporter Training (Ab1207). Advisory Note: Technical Violation (LIC9102TV) was issued.

At 10:10AM., Based on record review, LPA confirmed licensee CPR/ 1st aid certification has expired.



LPA reminded licensee to ensure emergency disaster drills are conducted every six months. Advisory Note: Technical Violation (LIC9102TV) was issued.

Required posting are posted in facility, including the Childcare License; Notification of Parent’s Rights (PUB379), Emergency Disaster Plan (LIC610A); Per licensee, isolation of an ill children is in the playroom.

Per licensee, she provides all food services for children in care. LPA advised licensee to ensure all children’s meal containers brought by families must be labeled. Per licensee, home does not have any firearms.

Licensee was reminded all adults, 18 years and over, living or working in the home, including employee and volunteers, 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 up to $500.00 maximum per day/ per person will be assessed if this regulation is violated.


(REFER TO 809C, FOR CONT.)
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2023
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: LAMA, NADIA V.
FACILITY NUMBER: 384004090
VISIT DATE: 06/29/2023
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(Page 3)
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.

To improve the quality and value of the new inspection process, a survey will 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, deficiencies were observed in areas evaluated according to California Title 22, Div. 12 Chap. 3 Health and Safety Code of Regulations and cited on 809D. LPA conducted exit interview with Nadia Lama, and licensees’ signature of this form acknowledges receipt of these documents.

Notice of today’s site visit was provided and must remain posted for 30 days.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2023
LIC809 (FAS) - (06/04)
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