384004699-4-19-2023-05-CC-HLEG-CR33A5-20230419180410

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384004699
Report Date: 04/19/2023
Date Signed: 04/19/2023 06:04:20 PM

Document Has Been Signed on 04/19/2023 06:04 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	RODRIGUEZ AGUILAR, JASMINE & SHANNON		FACILITY NUMBER:	384004699
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	04/19/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	04:30 PM
MET WITH:	Jasmine Rodriguez Aguilar		TIME COMPLETED:	06:19 PM

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On 4/19/2023, Licensing Program Analyst (LPA), Hanson Leong, conducted a scheduled, pre-licensing inspection with the Co-Applicant, Jasmine Rodriguez Aguilar. The two applicants requested a departmental visit after applying for a Small Family Child Care Home License. The LPA was granted entry by the co-applicant. The LPA explained the purpose of the visit to the co-applicant. The second applicant was not present for today’s visit. All the individuals listed on the facility’s roster have not been granted permission to work or be present in a childcare facility.

The two applicants rent the home. The two applicants intend to open from 7:30am to 5:00pm, Monday through Friday. Before children enroll, the co-applicant states that she will purchase liability insurance for her home day care. The LPA informed the co-applicant that if she does not purchase insurance for her childcare, she must notify the parents using the LIC 282 form. The two applicants plan to care for children ranging in from three months to five years old.

Day care area(s): Living Room, Dining Area, Bathroom, and Bedroom # 1

Off-limits area(s): Kitchen, and Master Bedroom. The co-applicant is aware off-limits areas are not to be used during business hours

Both LPA and the co-applicant conducted a health and safety inspection of the facility. The facility is clean and safe, with a working smoke, carbon monoxide detector and a fire extinguisher. The co-applicant has a first aid kit that is fully stocked with all the necessary supplies for treating injuries. There are no bodies of water in the facility. The two applicants have garbage cans with tightly fitting covered lids. At the home, the children in care have access to age-appropriate toys and equipment. The LPA reminded the co-applicant that baby walkers, bouncers, jumpers, and other similar equipment should not be used on children who are in care.

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SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2023

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: RODRIGUEZ AGUILAR, JASMINE & SHANNON	FACILITY NUMBER: 384004699
	VISIT DATE: 04/19/2023

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The co-applicant has a designated cell phone and is aware that it must be kept in the home during day care
hours. According to the co-applicant, there are no firearms or weapons in the home. The front of the house will be the isolation area for a sick child. All hazardous materials and toxins are kept out of children's reach and are inaccessible. The two applicants intend to serve snacks to the children and have the children bring their own lunch. The LPA observed that the applicant’s facility has resting mats and cribs for the children while they are napping.

The LPA reminded the co-applicant that the CPR and First Aid training must be renewed every two years. The two applicants have provided documentation demonstrating that they have been vaccinated against MMR and TDAP. The applicants have completed the Mandated Reporter Training. The LPA reminded the co-applicant that the Mandated Reporter Training must be renewed every two years.

The LPA informed the co-applicant that emergency disaster drills should be conducted at least once every six months and that the date and time of the drill should be recorded. If the two applicants provide care to the seventh and eighth child, who must be school aged, parent notification and landlord consent is required. The following is required to be posted in an accessible location in view of parents: Emergency Disaster Plan (LIC 610), Parent's Rights (LIC 995A), and License (once received).

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

Incidental Medical Services (IMS) policy was discussed with the co-applicant. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes 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 the publication: ***See Page 3 for continuation***

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2023

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: RODRIGUEZ AGUILAR, JASMINE & SHANNON	FACILITY NUMBER: 384004699
	VISIT DATE: 04/19/2023

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Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

A packet of forms pertaining to the children’s files and facility files were reviewed and discussed with the co-applicant. The co-applicant was advised all assistants, volunteers, frequent visitors or adults living in the home, over the age of 18 must be fingerprint cleared, associated to the home and have proof of immunization, prior to having any contact with the children in care. Failure to do so could result in an immediate civil penalty of $100 per person, each day.

The co-applicant 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. The LPA reviewed AB 1207 with the applicant.

The LPA will not recommend a Small Family Child Care Home License for the applicant until the following condition is met:
1. Applicant's Fingerprint Clearance

The applicant was advised to contact San Bruno Regional Office for concerns or questions. Desk Duty is available Mon-Fri, 8:00am to 5:00pm at (650) 266-8800. Forms and regulations are made available at www.cdss.ca.gov/inforesources/Community-Care-Licensing.

A copy of the report was given to the co-applicant, Jasmine Rodriguez Aguilar

An exit interview was conducted, and the report was reviewed with the Co-Applicant, Jasmine Rodriguez Aguilar

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2023

LIC809 (FAS) - (06/04)

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