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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004682
Report Date: 07/31/2023
Date Signed: 07/31/2023 11:49:09 AM

Document Has Been Signed on 07/31/2023 11:49 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:RAMIREZ ORTIZ, ANGELICA M.FACILITY NUMBER:
384004682
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
07/31/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Angelica Ramirez OrtizTIME COMPLETED:
11:55 AM
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On 7/31/2023 at 8:40AM., Licensing Program Analyst (LPA), Luis J. Gomez met with Licensee, Angelica Ramirez Ortiz. Purpose of inspection was explained and was for an Unannounced; Case Management inspection for Increase of Capacity/ Room Change. Present was the licensee, licensee’s son, and helper caring for two children. Children present are infant age. Licensee’s home is a 6 bedroom, 3 bathroom, 2 level house. Days and hours of operations are: Monday- Friday, 8:00AM.- 5:00PM. Daycare Areas are: Main Building: 2nd Level: Living Room (Playroom #1), Dining Room (Playroom #2), Bathroom #1; and Ground Level: Outside Play Area (Patio). Off-limit Areas are: Ground Level: Converted Garage: Bedrooms #1, #2, Bathroom #2; Main Building: Ground Level: Bedroom #3/ Office, Laundry Room, Bathroom #3, Main Building 2nd level: Bedrooms #4, #5, #6, Kitchen (Pass through only), and Hallway (Pass through only). LPA inspected home, inside and outside, with licensee for health and safety hazards.

At 8:50AM., the following was observed: Facility had age-appropriate playthings and materials available for the children. Toys and books inspected were in proper repair. Cubbies are available in playroom #2 for storage of children belongings. The off-limit areas have been made inaccessible. Licensee has child size tables and chairs are available for seated activities. Bathroom #1 was clean and fixtures in operating condition. Diaper changing table is located in playroom #2. LPA observed napping supplies: including several infant play pens, and cots. Playpen with tight-fitting sheet is available for each infant in care. Facility has sufficient ventilation. Facility has a functioning cell phone, smoke/ carbon monoxide combination detector and fire extinguisher (2A10BC). Detergents; toxins; cleaning compounds; and items (which could pose a danger) are stored in the off-limit areas.



At 9:15AM., LPA inspected the outdoor play area (Patio). Area was completely enclosed with playthings in good repair. Rubber turf has been installed for added safety. Home did not have pools, fishponds, spas, jacuzzi or any other bodies of water. (REFER TO 809C, FOR CONT.)
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 07/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/31/2023
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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: RAMIREZ ORTIZ, ANGELICA M.
FACILITY NUMBER: 384004682
VISIT DATE: 07/31/2023
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(PAGE 2)
Licensee’s Cardiopulmonary Resuscitation / First Aid certification is current, expiring on: 3/12/2024.
Licensee’s Mandated Reporter Training Certification (AB1207) is current, expiring on: 2/12/2024.

Per Licensee, she will provide daily snacks and meals. Isolation of an ill child will be in Playroom #1. Per licensee, home does not have any firearms.

Required forms are posted in entry way including: Facility license; Notification of Parent’s Rights (PUB294); and Emergency Disaster Plan (LIC610A).

At 11:00AM., Based on interview, LPA confirmed licensee missing required forms for infant-age child in care. Advisory Note: Technical Violation (LIC9102TV) was issued.

Licensee was informed that the Department must be notified prior to the use of designated off-limits areas. LPA and the licensee discussed licensing regulations and the capacity requirements. Any children under 10 years of age will be counted in the capacity. Licensee was advised that all food containers brought from home must be properly stored and labeled. Licensee understands the required emergency disaster drills are to be conducted and documented every six months. Licensee understands that the use baby walkers, bouncers, jumpers and similar items are not to be used for children in care. Smoking is prohibited inside a Family Childcare Home.

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 for influenza, pertussis and measles or qualifies for an exemption pursuant to Health and Safety Code 1596.7995 and 1597.662.

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.

The licensee provided proof of control of property and because applicant rents/ leases home, proof of landlord notification is required. The licensee obtained a signed Property Owner/ Landlords Consent form (LIC9149). (REFER TO 809C, FOR CONT.)
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2023
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: RAMIREZ ORTIZ, ANGELICA M.
FACILITY NUMBER: 384004682
VISIT DATE: 07/31/2023
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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.

Licensee was informed of the Mychildcareplan.org site, 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.

During inspection licensee submitted the updated LIC999, and LIC624.

Prior to recommendation for approval of change of location, licensee must complete the following:
-Required Fire Safety Approval (STD850)
-Finish set up for childcare services in playrooms #1, #2.
-Installed security latch on accessible windows in playrooms #1, #2.
-Remove all obstructions on ground surfaces in facility hallway
-Post the required Earthquake Preparedness Checklist (LIC9148)

Exit interview was conducted and report was reviewed with Licensee, Angelica Ramirez Ortiz. Copy of report was provided to licensee. This report will be kept in facility file and made available for public review upon request. Desk Duty is available Monday- Friday between 8AM - 5PM at (650) 266 -8800.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2023
LIC809 (FAS) - (06/04)
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