384004759-11-7-2024-05-CC-LGOZ-DASRDH-20241107115557

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384004759
Report Date: 11/07/2024
Date Signed: 11/07/2024 11:56:23 AM

Document Has Been Signed on 11/07/2024 11:56 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	ALVES, JESSICA		FACILITY NUMBER:	384004759
ADMINISTRATOR/ DIRECTOR:	ALVES, JESSICA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(628) 241-5082
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94110
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 10	DATE:	11/07/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:45 AM
MET WITH:	Yara Cruz, Jessica Alves		TIME VISIT/ INSPECTION COMPLETED:	12:15 PM

NARRATIVE

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On 11/7/2024 at 8:45AM., Licensing Program Analyst (LPA), Luis Gomez met with Assistant, Yara Cruz. The purpose of today’s visit was explained and was for an unannounced, annual/ random inspection. Licensee, Jessica Alves arrived during inspection. Present was the licensee and 2 assistants caring for 10 children. (2 infant-age, 8 preschool-age) Adults have criminal record clearances on file. Licensee home is a 3 bedroom, 2 bathroom, 2 level house. Per licensee days and hours of operations are Monday- Friday, 7:00AM.- 7:00PM. Areas of the home designated for childcare are: (Upper Level): Living Room (Playroom); Dining Room (Activity Area); Bathroom #1, Outdoor Patio Area. Areas of the home designated as off-limit areas are (Upper Level): Kitchen (pass through only); Bedrooms 1#, #2, Entire Lower Level): Bedroom #3; Bathroom #2; Living room #2; Garage; and Lower Backyard. LPA inspected facility for health and safety hazards.

At 8:55AM., the following was observed: Facility was clean, neat, with age-appropriate playthings and materials available for the children. Floors and ground surfaces were clear of any obstructions or hazards. Facility has several child safety gates preventing access to the off-limit areas. Accessible furniture, puzzles, and materials inspected were in proper repair. Licensee has several storage cubbies available for children’s belongings. LPA advised licensee to anchor tall storage cubbies against adjacent wall.

At 9:15AM., Based on observation, LPA confirmed baby bouncer chair in located in dining/ activity area. Chair was removed during inspection. Advisory Note: Technical Violation (LIC9102TV) was issued.

For food services, LPA observed tables and chairs, scaled to the appropriate size. Licensee has several tables with broad-base and detachable table component. For nap services, LPA observed play yard and mats stored in playroom. Play yards were equipped with correctly sized mattress. Per licensee, napping sheets are used during scheduled nap and washed weekly.

Bathroom #1 was observed clean with supplies for hand washing. Home was a comfortable temperature with adequate ventilation and lighting. Home had telephone service; carbon monoxide detector; smoke detector; and fire extinguisher (2A:10BC) in kitchen. The detergents, cleaning compound, and toxins have been stored in the off-limit areas. (REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 11/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2024

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 5

Document Has Been Signed on 11/07/2024 11:56 AM - It Cannot Be Edited

Created By: Luis Gomez On 11/07/2024 at 10:47 AM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: ALVES, JESSICA	FACILITY NUMBER: 384004759
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/07/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(b)

Operation of A Family Child Care Home

(b) The home shall be kept clean and orderly, with heating and ventilation for safety and comfort. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	At 9:31AM., Based on observation, LPA confirmed excessive leaves, boxes, and debris is backyard patio area. This poses a potential health and safety risk to children in care.
	POC Due Date: 11/11/2024
	Plan of Correction
1 2 3 4	Licensee will remove all hazardous items from patio area by the due date: 11/11/2024. Proof of correction will be submitted to Department via email.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Marie Rodriguez

LICENSING EVALUATOR NAME:

Luis Gomez

LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2024

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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: ALVES, JESSICA	FACILITY NUMBER: 384004759
	VISIT DATE: 11/07/2024

NARRATIVE

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(PAGE 2)
At 9:30AM., LPA inspected the backyard area (patio). Home did not have any pools; fishpond; jacuzzi; or other bodies of water.

At 9:31AM., Based on observation, LPA confirmed excessive leaves, boxes, and debris is backyard patio area. Per licensee, patio area is not in use at this time.

At 9:50AM., LPA reviewed facility records including the children and personnel files. The children’s files were reviewed and included the: Identification and Emergency Information (LIC700); Individual Infant Sleeping Plan (LIC9227); Notification of Parent’s Rights (LIC995); Consent for Medical Treatment (LIC612); and Immunization Records.

Licensee is maintaining logs, documenting each 15 minute review for napping infants in care.

The staff files were reviewed and included the: Notification of Employee Rights (LIC9052); Acknowledgement to Report Suspected Child Abuse (LIC9108); and Proof of completed mandated reporter training course (AB1207).

Licensee proof of completed mandated reporter training course (AB1207) of was current, expiring: 7/2026.
Licensee’s Cardiopulmonary Resuscitation/ First Aid Certification (CPR) was current, expiring: 3/2026.
Per licensee, facility is conducting regular emergency disaster drills, with last drill logged and dated: 7/1/2024.

The required forms are posted in facility and include the: Child Care License; Notification of Parent’s Rights (PUB379); Client Roster (LIC9042); and Emergency Disaster Plan (LIC610).

Per licensee, isolation of an ill child is in the dining area. Per licensee, facility provides daily food services for children in care.

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. (REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 11/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2024

LIC809 (FAS) - (06/04)

Page: 4 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: ALVES, JESSICA	FACILITY NUMBER: 384004759
	VISIT DATE: 11/07/2024

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(PAGE 3)
LPA discussed safe sleep regulations with licensee and the 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.

Facility was informed of the www.mychildcareplan.org site is 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

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tool, please send them to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesource/community-care-licensing/inspection-process.

Based on today's inspection, deficiencies were observed in areas evaluated according to California Title 22, Div. 12 Chap. 3, Health and Safety, Code of Regulations and cited on 809D. Exit interview discussing facility evaluation report and plans for correction was completed with Licensee, Jessica Alves. Licensee’s signature of this form acknowledges the receipt of these documents.

During exit interview, licensee confirmed no registered sex offenders are living in the facility, and LPA completed RSO profile. Notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 11/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2024

LIC809 (FAS) - (06/04)

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