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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004355
Report Date: 11/12/2024
Date Signed: 11/12/2024 10:44:23 AM

Document Has Been Signed on 11/12/2024 10:44 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:MARTINEZ, MIRZAFACILITY NUMBER:
384004355
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 4CENSUS: 3DATE:
11/12/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:25 AM
MET WITH:Mirza MartinezTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
NARRATIVE
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On November 12, 2024, Licensing Program Analyst (LPA) Van conducted an annual random inspection and met the Licensee, Mirza Martinez. LPA explained the purpose of the inspection to the Licensee and was given access to the home. Upon entering the house, LPA observed all the children were having their morning snacks. The licensee supervised three children (two preschoolers and an infant). The licensee complies with the licensing capacity and limits today. During the visit, the licensee’s husband came home. All staff present during the inspection have had their criminal record clearance verified with the CDSS Background Check System, and they are found to have eligible clearance status on file.

According to the Licensee, there were no changes to the previously approved childcare areas. Childcare areas are provided only on the first floor, consisting of the Living Room (playroom) and Bathroom #1. The off-limit areas are the First Floor: Living Room #2, Kitchen, Back Patio/ Balcony, Laundry Room, and the Second Floor: Bedroom #1, Bedroom #2, Bedroom #3, Bathroom #2, and Bathroom #3. All off-limit areas are appropriately barricaded. Days and operations hours are Monday – Friday from 8:30 am – 5:30 pm.

During the visit, the licensee requested to add living room #2 on the first floor to the license. An inspection of living room #2 revealed that it was clean and free of any hazards. As of today, November 12, 2024, living room #2 has been officially incorporated into the license. The licensee provided the new facility sketch to LPA during the inspection.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE: DATE: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/24/2024
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: MARTINEZ, MIRZA
FACILITY NUMBER: 384004355
VISIT DATE: 11/12/2024
NARRATIVE
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LPA and the Licensee inspected the childcare areas for any potential dangers to health and safety hazards. The childcare areas were clean and organized. The facility has age-appropriate books and activities to help children learn and play. The areas also had good heating, lighting, and ventilation, and no potential hazards posed any risk to children. The house has a combination carbon monoxide and smoke detector and a fully charged fire extinguisher with a minimum standard specification of 2A 10 BC. Cleaning products and disinfectants were stored inaccessible to children. Fully stocked first aid supplies are available for children. According to the Licensee, there are no firearms or weapons. No pools, spas, or bodies of water were on the premises. LPA did not observe walkers, bouncers, or similar items in the home. Licensees acknowledged that smoking is prohibited in family childcare homes.

Two playpens were inspected, and both were found to be free of toys, blankets, and pillows. However, one of the playpens did contain a loose bedsheet. According to the licensee, this sheet is only used when the infant is awake and needs to be placed in the playpen. The licensee also mentioned that the sheet is removed when the infant naps and lays directly on the padding. The 15-minute sleep logs for infants were checked, and it was noted that the licensee had accurately documented the logs, including the date and 15-minute increment of each check.

LPA discussed and informed the Licensee that she must be present at home to ensure that the children in her care are always supervised. When the licensee must be absent from the house, the temporary absence should not exceed 20 percent of the hours the facility provides care per day.

During the visit, LPA reviewed the records for both children and personnel. The licensee consistently keeps accurate records for each child, including vaccination records, parental rights forms, and complete emergency information. The licensee has maintained records of all essential licensing requirements, such as necessary immunizations, valid Pediatric First Aid CPR certifications, and up-to-date mandated reporter training.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2024
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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: MARTINEZ, MIRZA
FACILITY NUMBER: 384004355
VISIT DATE: 11/12/2024
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All the required licensing postings were observed posted. According to the licensee, regular fire and earthquake drills are conducted at least once every six months, with the most recent drills completed on 11/5/2024.

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.

Incidental 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: www.ada.gov/childqanda.htm.

LPA discussed the safe sleep regulations with the Licensees and discussed the Child Care Licensing Safe Sleep webpage https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed the Licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2024
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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: MARTINEZ, MIRZA
FACILITY NUMBER: 384004355
VISIT DATE: 11/12/2024
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Licensee was informed that as of September 1, 2016, a person may not be employed or volunteer at a childcare facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.

LPA reviewed AB 1207 with the Licensees. As of January 1, 2018, all staff must complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

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 tools, please send them by email 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/inforesources/community-care-licensing/process.

During the exit interview, the LICENSEE, MIRZA MARTINEZ, confirmed that there are no Registered Sex Offenders living in the facility, and LPA completed the RSO profile in FAS.

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, Mirza Martinez.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2024
LIC809 (FAS) - (06/04)
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