384004829-1-18-2024-05-CC-JYEE-CZLUHG-20240118143555

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384004829
Report Date: 01/18/2024
Date Signed: 01/18/2024 02:36:00 PM

Document Has Been Signed on 01/18/2024 02:36 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:	ZAMORA GOMEZ, SANDRA		FACILITY NUMBER:	384004829
ADMINISTRATOR:	ZAMORA GOMEZ, SANDRA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 756-6533
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94112
CAPACITY:	14	CENSUS: 0	DATE:	01/18/2024
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Sandra Zamora Gomez		TIME COMPLETED:	02:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst, LPA Yee conducted a pre-licensing inspection today. This is a change of location and increase in capacity. LPA, and the applicant, Sandra toured the entire home for health and safety hazards. Sandra is the only person that lives in the home. Days and hours of operation: Monday to Friday between 7:00 AM to 5:00 PM. Day Care Areas (lower level): Classroom #1, classroom #2, patio, and bathroom. Backyard is not licensed today. When the facility is ready, the facility needs to contact the CCL office for approval. Off-limit areas: the entire upper level: master bedroom, bedroom #1, full bathroom, kitchen, dining room, and living room. The applicant leases this home and the control of the property is on file. The home is equipped with a carbon monoxide detector, a smoke detector, and a fire extinguisher size 2A10BC. LPA advised them to conduct emergency drills once every six months and keep a log sheet. CPR and 1st aid will expire 02/2024. The applicant is signed up to renew the class on Feb-03-2024. The facility does not have a body of water such as a swimming pool, or hot tub. No pets. Discipline policy was discussed. The facility will provide meals. The gate is used to prevent children from going to the off-limit areas. LPA reviewed AB 1207 with the applicant. As of January 1, 2018, all staff members are required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. The applicant has a current AB 1207 on file. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Sections 102417. 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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, Available at: http://www.ada.gov/childqanda.htm

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer Yee	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024

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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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: ZAMORA GOMEZ, SANDRA	FACILITY NUMBER: 384004829
	VISIT DATE: 01/18/2024

NARRATIVE

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Applicant was reminded that all adults 18 and over living or working in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and
volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, before 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.

Because the applicant rents the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC9149).

LPA discussed the safe sleep regulations with the licensee 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 licensee 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.

Individual Infant Sleeping Plan (LIC9227) form was discussed and provided. LIC9227 is for Infant under 12 month old. When the infant(new born to 24 month old) is napping, it needs to be checked every 15 mins and documented on a log sheet.A log sheet needs to be in the children file for 2 years. A sample log sheet was explained and provided. Technical support for COVID was discussed. Website for forms and regulations: www.ccld.ca.gov.

On this date 01/09/2024, 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.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer Yee	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024

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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: ZAMORA GOMEZ, SANDRA	FACILITY NUMBER: 384004829
	VISIT DATE: 01/18/2024

NARRATIVE

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

LPA reviewed with Sandra, the LIC311D, 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.

Exit interview conducted and report was reviewed with the applicant, Sandra.

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-care-licensing/subscribe and select the Child Care option to receive email communication.

A capacity worksheet was explained and provided.

A large FCCH license will be recommended after receiving a fire clearance approval.

Office: 650-266-8800, Monday - Friday
cclsanbrunocc@dss.ca.gov

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer Yee	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024

LIC809 (FAS) - (06/04)

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