<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004356
Report Date: 01/14/2025
Date Signed: 01/14/2025 03:50:14 PM

Document Has Been Signed on 01/14/2025 03:50 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:DIAS, ANA PAULAFACILITY NUMBER:
384004356
ADMINISTRATOR/
DIRECTOR:		DIAS, ANA PAULAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 407-6424
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94112
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 10DATE:
01/14/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:55 PM
MET WITH:Ana Paula DiasTIME VISIT/
INSPECTION COMPLETED:
04:05 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 1/14/2024 at 12:55PM., Licensing Program Analyst (LPA), Luis Gomez met with Licensee, Ana Paula Dias. The purpose of today’s visit was explained and was for an unannounced, annual random inspection. Present was the licensee, licensee’s husband, and assistant caring for 10 children. (3 infant-age, 7 preschool-age). Adults have criminal record clearances on file. Licensee’s home is a three bedroom, one bathroom, one level house. The days and hours of operations are: Monday- Friday, 8:00AM- 11:00PM. The areas of the home designated for childcare are: Bedroom #1; Covered Deck (Playroom); Kitchen; and Bathroom #1. Areas of the home designated as off-limits: Bedroom #2, Bedroom #3, and Garage. LPA inspected facility for health and safety hazards.

At 1:00PM, the following was observed: Facility was clean, neat, with age-appropriate playthings available for the children. The floors and ground surfaces were clear of any obstructions or hazards. Labeled cubbies are available for storage of children’s belongings. LPA observed table, chairs in kitchen, scaled to the appropriate size. Accessible furniture, materials, and supplies inspected were in good repair, free of sharp corners or splinters.

For napping services, napping mats and playpens are stored in bedroom #1. LPA observed play pen with tight-fitting sheet, available for each infant-age child in care. Bathroom #1 was observed clean and in operating condition. Diaper changing table is available as needed. Detergents, cleaning compounds, and item which can pose a danger, have been stored on high hanging shelf. Home was a comfortable temperature, ventilation, and lighting. Home has telephone service; carbon monoxide/ smoke combination detector and fire extinguisher (2A:10BC). (REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/14/2025
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: DIAS, ANA PAULA
FACILITY NUMBER: 384004356
VISIT DATE: 01/14/2025
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)
Home does not have any pools; fishpond; jacuzzi; or other bodies of water.

At 1:40PM., LPA reviewed facility records including the children and staff files.
The staff file was reviewed and included the Proof of Immunization; Notice of Employee Rights (LIC9052); Proof of completed Mandated Reporter Training course (AB1207); Statement Acknowledging Requirement to report suspected Abuse (LIC9108).

The children’s files were reviewed and included the: Identification and Emergency Information (LIC700); Notification of Parents Rights (LIC995); Immunization Records; and Individual Infant Sleeping Plan (LIC9227) for qualifying infants age children in care.

Facility is documenting review of napping infants during each 15 minutes. Documentation maintained includes the date, time, and child’s name.

Licensee’s cardiopulmonary resuscitation (CPR)/ Pediatric First Aid Certification was current, expiring: 3/2026.
Licensee’s completed mandated reporter training course (AB1207) was current, expiring 10/2025

Facility is conducting emergency disaster drills every six months, with last drill completed on 9/8/2024.

The required forms are posted in entry and include the: License; Notification of Parent’s Rights (PUB379); and Written Emergency Disaster Plan (LIC610).

Per licensee, isolation of an ill child is in the playroom. Per licensee, facility provides daily snack/ meal services for children in care. LPA observed pet dog on site. (REFER TO 809C, FOR CONT.)

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

DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2025
LIC809 (FAS) - (06/04)
Page: 2 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: DIAS, ANA PAULA
FACILITY NUMBER: 384004356
VISIT DATE: 01/14/2025
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)
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 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.



Facility 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.(REFER TO 809C., FOR CONT.)
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2025
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: DIAS, ANA PAULA
FACILITY NUMBER: 384004356
VISIT DATE: 01/14/2025
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 4)
Based on today's inspection, no deficiencies were observed in areas evaluated according to California Title 22, Div. 12 Chap. 3, Health and Safety Code of Regulations. An exit interview and facility evaluation report was discussed with Licensees, Ana Paula Dias.
Licensee’s 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.

LPA unable to print report during inspection. Copy of report will be sent to provider at a later date.

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

DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2025
LIC809 (FAS) - (06/04)
Page: 4 of 4