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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004789
Report Date: 11/21/2023
Date Signed: 11/21/2023 04:42:52 PM


Document Has Been Signed on 11/21/2023 04:42 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:RUIZ, KORAIMA A.FACILITY NUMBER:
384004789
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
11/21/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Koraima RuizTIME COMPLETED:
05:10 PM
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Licensing Program Analyst (LPA) Mok, conducted an announced Prelicensing Inspection. LPA met with the applicant, Koraima Ruiz, and her husband. All adult residents have fingerprint clearance. The applicant applied for a small family child care home license on 9/27/23. The applicant rents and lives with her husband, her sister, her brother-in-law, and their 2 minor children in this 3-level house. The house has 3 bedrooms, 2 bathrooms, a living, a dining room, and a kitchen on the upper; 2 bedrooms, a bathroom, a living room, and a garage on the street level; 2 bedrooms, a living room with a kitchenette, a storage area and a backyard on the lower level. The daycare areas are the entire lower level except for a storage area and backyard, a living room on the street level is used as pathway only (children cannot stay in this area for any activities) to the main daycare area on the lower level and a bathroom on the street level. The off-limit areas are the entire upper level, 2 bedrooms on the street level, a storage area, and a balcony & backyard on the lower level. The facility will be called ARBOLEDA ESCUELA. The operation hours will be Monday to Friday from 7:30 AM to 5:00 LPA toured and inspected the house for health and safety hazards. The facility was clean and in order. The lighting and temperature were adequate. The applicant made all the toxins and harmful objects inaccessible to the children. The applicant installed gates at the stairway from the street level to the lower level and the entrance from the stairway to the living room on the lower level. The applicant also latched the sliding door in bedroom #1 to prevent the children from accessing the deck. All the lower drawers and cabinets were latched at the kitchenette in the living room. There was a fully charged 2A10BC fire extinguisher, working 2in1 smoke and carbon monoxide detectors, working cellular phone, and first aid supplies available in the daycare areas. There were plenty of age-appropriate toys, books, learning materials, and equipment and the children's furniture was in good condition and repaired available for the children. The applicant also set up a Potty corner with potties and sinks for the young children in the living room. All the electrical outlets and sharp corners were covered. The applicant installed a childproof window lock to the window to limit the window to be opened up to 4 inches. The children's bathroom is on the street level. The bathroom was clean and in order. The lower bathroom sink cabinet and drawers were latched. The applicant made all the toxins and harmful objects inaccessible to the children there. The facility had cribs and cots available for napping. Booster was available in the living room for feeding only; a child must be removed from it after a meal. Per the applicant, there were no guns, weapons, or pets at home. Per the applicant, she plans to provide breakfast, AM/PM snacks, and lunch to the children. The children may bring their food to the daycare if necessary, The Applicant had current CPR/First Aid and Child Abuse Mandated Reporter Training. LPA discussed with the applicant that baby bouncers, baby walkers, exersaucer, Nap Nannies, nap portable, and other similar items are not allowed in daycare areas.

Continues on LIC 809C
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy MokTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 11/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/21/2023
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: RUIZ, KORAIMA A.
FACILITY NUMBER: 384004789
VISIT DATE: 11/21/2023
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Criminal Record Statement:

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, must obtain a criminal record 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.

Safe Sleep

LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed [applicant, licensee, or facility representative] of 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)

APPLICANT WILL WAIT UNTIL FACILITY OPENS TO DETERMINE IMS NEEDS:

Incidental Medical Services (IMS) policy was discussed. For IMS information , see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing 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 publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy MokTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2023
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: RUIZ, KORAIMA A.
FACILITY NUMBER: 384004789
VISIT DATE: 11/21/2023
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Landlord Consent-The applicant provided proof of control of property.

Review of records to be maintained: LPA reviewed with applicant the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant.

Megan’s Law - Family Child Care Homes On this date, 9/27/2023, 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 have been 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.

MyChildCarePlan.org--Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Exit Interview - Exit interview conducted and report was reviewed with the applicant.
Please include their name. Subscribe to CCLD important information - Child Care Centers and Family Child Care Homes: 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 information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy MokTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2023
LIC809 (FAS) - (06/04)
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