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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004713
Report Date: 04/20/2023
Date Signed: 04/20/2023 04:47:18 PM

Document Has Been Signed on 04/20/2023 04:47 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:BANOS, KAREN Y.FACILITY NUMBER:
384004713
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
04/20/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:Karen Banos TIME COMPLETED:
05:00 PM
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On 4/20/2023 at 2:35PM., Licensing Program Analyst (LPA), Luis J. Gomez met with Licensee, Karen Banos. Purpose of inspection was explained and was for an Announced; Prelicensing inspection for change of location. Licensee's previous license is #384004271. Present was the licensee, licensee’s mother and no children. Licensee’s home is a 4 bedroom, 2 bathroom, 2 level house. Days and hours of operations are: Monday- Friday, 7:30AM.- 5:00PM. Daycare Areas are: Upper Level: Living Room (Playroom #1), Family Room (Playroom #2) and Bathroom #1. Off-limit Areas are: Upper Level: Kitchen, Bedroom #1, #2, #3, Lower Level: Foyer, Bedroom #4, Bathroom #2, Garage, and Backyard Area. LPA inspected home, inside and outside, with licensee for health and safety hazards.

At 2:40PM., the following was observed: Home was clean, orderly, with age-appropriate playthings and materials available. Off-limit areas and staircase have been made inaccessible with child safety gate. Floor and ground surfaces were clear of obstructions. Furniture, toys and books inspected are in good repair. Fireplace has been barricaded. Bathroom #1 was clean, with fixtures in operating condition. Diaper changing table is located in playroom #2. For napping services, LPA observed infant crib with tight-fitting sheet. Home has sufficient ventilation and lighting. Accessible electrical outlets have been covered. Home has a functioning cell phone, smoke/ carbon monoxide combination detector and fully charged fire extinguisher (2A10BC). Detergents; toxins; cleaning compounds; and items (which could pose a danger) are stored in the off-limit areas.

Home did not have pools, fishponds, spas, jacuzzi or any other bodies of water.

At 3:10PM. LPA and licensee reviewed: Records to Keep in Your Family Child Care Home (LIC311D); Children's Forms/ Records; Facility Forms; and Information to be Posted. (REFER TO 809C, FOR CONT.)
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 04/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/20/2023
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: BANOS, KAREN Y.
FACILITY NUMBER: 384004713
VISIT DATE: 04/20/2023
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(PAGE 2)
Licensee’s Cardiopulmonary Resuscitation / First Aid certification is current, expiring on: 10/2023. Mandated Reporter Training Certification (AB1207) is current, expiring on: 2/2025.

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

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 informed that all adults 18 years and over, living or working in the home, including employee and volunteers, 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 up to $500.00 maximum per day/ per person will be assessed if this regulation is violated.

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. (REFER TO 809C, FOR CONT.)
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023
LIC809 (FAS) - (06/04)
Page: 2 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: BANOS, KAREN Y.
FACILITY NUMBER: 384004713
VISIT DATE: 04/20/2023
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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

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 communication platform.


To receive important licensed- related information to licensed facilities, visit the CCLD important information website at https://www.cdss.ca.gov/infosource/community-care-licensing/subscribe and select the child care option to receive email communication.

Prior to recommendation for approval of change of location, licensee must complete the following:
-Post all required forms in visible location
-Install child safety lock door for Bedroom #1
-Finish Moving into home

Exit interview and report was conducted with Licensee, Karen Banos, and copy of this report was provided. This report will be kept in the 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: 04/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023
LIC809 (FAS) - (06/04)
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