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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004246
Report Date: 06/21/2024
Date Signed: 06/21/2024 03:56:02 PM

Document Has Been Signed on 06/21/2024 03:56 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:VALDERRAMOS,KATERINE C.FACILITY NUMBER:
384004246
ADMINISTRATOR/
DIRECTOR:		VALDERRAMOS,KATERINE CFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 627-7476
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94112
CAPACITY: 14; 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
06/21/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Katrine Valderramos TIME VISIT/
INSPECTION COMPLETED:
04:10 PM
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On 6/21/2024 at 1:15PM., Licensing Program Analyst (LPA), Luis Gomez met with Licensee, Katerine Valderramos. The purpose of today’s visit was explained and was for an unannounced, annual random inspection. Present was licensee and assistant caring for 8 children (3 infant-age, 5 preschool-age). All adults have criminal record clearances on file. Days and hours of operations are Monday- Friday, 7:30AM.- 5:30PM. Licensee’s home is a 3 bedroom, 2 bathroom, 2 level house. Areas of the home designated childcare are the: Living Room (Playroom); Bathroom #1; Bedroom #1; Kitchen; Dining Room (Play room); and Backyard Area. Areas of the home designated as off-limit areas are: Upper Level: Bedroom #2; Bedroom #3; and Bathroom #2. LPA inspected home with licensee for health and safety hazards.

At 1:20PM., the following was observed: Facility was clean, neat, with age-appropriate playthings available for the children. The floors and ground surfaces were clear of obstructions. Accessible furniture, books, and playthings inspected were in proper repair. LPA observed individual cubbies for storage of children’s belongings. Accessible chairs and table are scaled to the appropriate size.

For napping services, LPA observed cots and cribs stored in facility. Cribs are equipped with tight-fitting sheets and mattress. Per licensee, napping supplies are washed weekly.

Bathrooms #1 was observed clean with supplies for hand washing. Diaper changing table is available. Home was a comfortable temperature with ventilation and lighting. The off-limit areas of the home had been made inaccessible with child safety gate. Accessible staircase have been barricaded. Home had telephone service; functioning carbon monoxide detector; smoke detector; and fire extinguisher: 2A:10BC located in the kitchen.

At 1:40PM., LPA inspected the outdoor area. Area was enclosed with tall fencing. Outside playthings were in good repair. Home does not have any pools, fishpond, jacuzzi, or other bodies of water. (REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 06/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/21/2024
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: VALDERRAMOS,KATERINE C.
FACILITY NUMBER: 384004246
VISIT DATE: 06/21/2024
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At 2:00PM., LPA reviewed facility records including the children and personnel files. The children’s files were reviewed and included the: Emergency Information (LIC700); Notification of Parent’s Rights (LIC995A); Consent for Medical Treatment (LIC627); Individual Infant Sleeping Plan (LIC9227) for qualifying infants in care; and Immunization Record.

Licensee is documenting napping conditions during each 15-minute review.

The personnel files reviewed contained the: Notice of Employee Rights (LIC995A); Acknowledgement to Report Suspected Child Abuse (LIC9108); Proof of Required Immunization; and Personnel Record (LIC501).

Licensee’s Mandated Reporter Training (AB1207) was current, expiring: 2/2026.
Licensee’s Cardiopulmonary Resuscitation (CPR)/ First Aid certification was current, expiring: 1/2026.
The provider is conducting disaster drill every six months, with last drill completed on 6/17/2024.

The required forms are posted in facility and include the: Child Care License; Notification of Parent’s Rights (PUB379); and Emergency Disaster Plan (LIC610A).

Per licensee, isolation of an ill child is in the playroom. Per licensee, she provides daily snack and lunches 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. (REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2024
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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: VALDERRAMOS,KATERINE C.
FACILITY NUMBER: 384004246
VISIT DATE: 06/21/2024
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LPA and licensee discussed the 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.

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.

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, Ca. Code of Regulations. Exit interview and report was reviewed with licensee, Katerine Valderramos. 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: 06/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2024
LIC809 (FAS) - (06/04)
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