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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004687
Report Date: 03/15/2023
Date Signed: 03/15/2023 11:27:50 AM

Document Has Been Signed on 03/15/2023 11:27 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:GUTIERREZ, ANTONIOFACILITY NUMBER:
384004687
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
03/15/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:46 AM
MET WITH:Antonio GutierrezTIME COMPLETED:
11:32 AM
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On March 15, 2023, Licensing Program Analyst (LPA), Sheran Lo met with applicant, Antonio Gutierrez, for a schedule pre-licensing inspection at the facility. Present is the applicant. Applicant rents the home, which is a two bedroom, one bathroom, one level, single family house. Living in the home is applicant. Criminal record clearances are on file. Days and hours of operation are Monday - Friday, 8:00 AM. to 5:00 PM or as needed. Childcare Area: Living Room (Playroom), Bedroom #2 (Napping Room), Bathroom, Kitchen (Pass through only), and back porch. Off-limit Area: Bedroom #1, Garage, and Backyard. LPA inspected home with applicant for health and safety hazards.

The following was observed: Childcare area was clean and orderly with a variety of age appropriate wooden toys, books and games for the children. Furniture and playthings inspected are new and in good condition. Napping room, located next to the playroom, had a large area with crib and cots. The children’s nap supplies were stored in the napping room closet. Baskets and hangers had been added to the facility hallway for storage of children’s belongings. Playroom had two child size table and several chairs for meals and activities. Per applicant, children will be served meals in the playroom. Accessible cabinets and drawers in the kitchen and bathroom #1 had child safety locks installed. Bathroom #1 was in operating condition with adequate supplies. The house had six windows for ventilation and lighting. LPA observed all accessible electrical outlets, trash bins had been properly covered. Detergents and cleaning supplies were made inaccessible, stored under the kitchen sink. Facility has functioning cell phone, smoke/ carbon monoxide detector combo and fire extinguishers (2A:10:BC). Per applicant, there are no pets in the home.

Per applicant, there are no guns or weapons in the home. Bedrooms were free of hazards or dangerous conditions. Isolation area for an ill child will be in the playroom. Applicant was informed that the Department must be notified that prior to use of any off-limits areas. Licensing forms and posting requirements were reviewed with the applicant. LPA discussed licensing regulations and the capacity requirements. Any children under 10 years of age will be counted in the capacity.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Sheran Lo
LICENSING EVALUATOR SIGNATURE: DATE: 03/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/15/2023
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 2
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: GUTIERREZ, ANTONIO
FACILITY NUMBER: 384004687
VISIT DATE: 03/15/2023
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Applicant stated she plans to provide food for the children. LPA reminded applicant that food brought from home should be properly labeled. Applicant understands that fire/earthquake drills are to be conducted every six months and recorded. Applicant understands that baby walkers, bouncers, and excersaucers are not allowed. Smoking is prohibited in family childcare homes. Applicant's CPR/1st Aid certification was current, expiring: 6/2024. Mandated Reporter Training was current, expiring: 12/2024.

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed applicant 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.

This facility plans to provide Incidental Medical Services – IMS. For IMS information , see PIN 22-02-CCP. 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: http://www.ada.gov/childqanda.htm

Exit interview conducted and report was reviewed with the applicant Antonio Gutierrez.

LPA reviewed with applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted

Entrance Checklist was provided to the applicant.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Sheran Lo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2023
LIC809 (FAS) - (06/04)
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