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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004785
Report Date: 02/13/2024
Date Signed: 02/13/2024 11:18:48 AM

Document Has Been Signed on 02/13/2024 11:18 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:BELTRAN, JAQUELINE B.FACILITY NUMBER:
384004785
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
02/13/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Jaqueline BeltranTIME COMPLETED:
11:30 AM
NARRATIVE
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On 2/13/2024 at 9:25AM., Licensing Program Analysts (LPAs), Luis Gomez and Sheran Lo met with licensee, Jaqueline Beltran. Purpose of unannounced inspection was explained, and was to report investigation findings. This case management report is to cited for deficiency found during investigation. Present was the licensee and 2 helpers and caring for 6 children (2 infant-age, 4 preschool-age). LPAs inspected facility for health and safety hazards.

Based on information obtained, adult occupant (O1) assisted in childcare without criminal record clearance on file.

During inspection, LPAs reminded licensee, any children under 10 years of age will be counted towards the capacity.

During inspection, LPAs 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.

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.

***See attached page for deficiency cited against the facility under CCR, Title 22, Div. 12, Ch. 3.***



This report and rights to comment were discussed. This report must be available in the facility for public review. Notice was given and must remain posted for 30 days. Facility was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 02/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/13/2024
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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Document Has Been Signed on 02/13/2024 11:18 AM - It Cannot Be Edited


Created By: Luis Gomez On 02/13/2024 at 10:02 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: BELTRAN, JAQUELINE B.
FACILITY NUMBER: 384004785

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/13/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/14/2024
Section Cited
CCR
102370(d)

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102370(d) Criminal Record Clearance (d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility. This requirement was not met a evidenced by:
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Adult helper has received criminal record clearance and association.

Deficiency was cleared during inspection.
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Based on information obtained, adult occupant (O1) assisted in childcare without criminal record clearance on file. This poses a potential health and safety risk to children in care.
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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: 02/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/13/2024


LIC809 (FAS) - (06/04)
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