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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004759
Report Date: 07/27/2023
Date Signed: 07/27/2023 11:42:31 AM

Document Has Been Signed on 07/27/2023 11:42 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:ALVES, JESSICAFACILITY NUMBER:
384004759
ADMINISTRATOR:ALVES, JESSICAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(628) 241-5082
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 1DATE:
07/27/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Jessica AlvesTIME COMPLETED:
11:50 AM
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On 7/27/2023 at 8:50AM., Licensing Program Analyst (LPA), Luis J. Gomez met with Licensee, Jessica Alves. Purpose of inspection was explained and was for an Announced; Prelicensing inspection for change of location. Licensee is applying for large capacity licensure. Present was the Licensee and Licensee’s son. Licensee home is a 3 bedroom, 2 bathroom, 2 level house. Days and hours of operations are: Monday- Friday, 7:00AM.- 5:00PM. Licensee stated she may provide services nights and weekends. Daycare Areas are: (Upper Level): Living Room (Playroom); Dining Room (Activity Area); Kitchen (Pass through only); Bathroom #1, Outdoor Patio Area. Off-limit Areas are: (Upper Level): Bedrooms 1#, #2, (Entire Lower Level): Bedroom #3; Bathroom #2; Living room #2; Garage; and Lower Backyard. LPA inspected home with licensee for health and safety hazards.

At 8:55AM., the following was observed: Home was clean, orderly, with age-appropriate playthings and materials available. Floor/ ground surfaces were clear of obstructions or potential hazards. Activity room has child- sized tables and chairs for seated activities. Bathroom #1 was maintained clean with supplies for hand washing. Playroom windows have safety locks installed. For napping services, LPA observed play pens available playroom. Off-limit areas have been made inaccessible. Staircase has been made inaccessible. Home had proper ventilation and lighting. Home has a cell phone, smoke detector, carbon monoxide detector, and fully charged fire extinguisher (2A10BC). Per licensee, cell phone will always stay in the home. Detergents; toxins; cleaning compounds; and items (which could pose a danger) are stored in the off-limit areas.

At 9:15AM., LPA inspected Outdoor Patio Area. Area was completely enclosed, with playthings in proper repair. Stairs case leading to lower level have been barricaded. Home does not have any pools, jacuzzi, fishponds, or bodies of water on site.

LPA reviewed with Licensee, the LIC311D, Records to Keep in Your Family Child Care Home, Children's Forms/ Records; Facility Forms/Records; and Information to be Posted. Entrance Checklist was provided to the licensee. (REFER TO 809C, FOR CONT.)
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 07/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/27/2023
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: ALVES, JESSICA
FACILITY NUMBER: 384004759
VISIT DATE: 07/27/2023
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(PAGE 2)
Licensee’s Cardiopulmonary Resuscitation / First Aid certification is current, expiring: 5/2025.
Licensee’s ‘Mandated Reporter Certification’ (AB1207) was current, expiring: 6/7/2024.

Per Licensee, she plans to provide food services. Isolation of an ill child will be in the playroom. Per licensee, home does not have any firearms.

Required forms are posted in entry way including: the Notification of Parent’s Rights (PUB294); Emergency Disaster Plan (LIC610A), and Earthquake Preparedness Checklist (LIC9148).

Licensee was informed that the Department must be notified prior to the use of designated off-limits areas. LPA and the applicant 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).

LPA and Licensee 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: 07/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2023
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: ALVES, JESSICA
FACILITY NUMBER: 384004759
VISIT DATE: 07/27/2023
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On 7/12/2023, the California Attorney General – Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California’s Megan’s Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not be included in this search. However, the department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

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.



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.

During inspection licensee submitted the: LIC9217 and Proof of Immunization.

Prior to recommendation for change of location/ large capacity, licensee must complete the following:
Required Fire Safety Approval, STD850

Exit interview was conducted and report was reviewed with Applicant, Jessica Alves. 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: 07/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2023
LIC809 (FAS) - (06/04)
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