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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004836
Report Date: 02/06/2024
Date Signed: 02/06/2024 10:53:04 AM

Document Has Been Signed on 02/06/2024 10:53 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:GONZALEZ, HASSELFACILITY NUMBER:
384004836
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
02/06/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Hassel GonzalezTIME COMPLETED:
11:15 AM
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On February 6, 2024, at approximately 8:30am, Licensing Program Analyst (LPA) Nasiripour conducted an announced Pre-licensing Inspection. LPA met with the Licensee, Hassel Gonzalez, and Licensee's daughter, Kelly Aguilar, for the inspection. Licensee had a previous FCCH: 384 001 494.

The Licensee owns and lives in the 3-story, 3-bedroom, 2-bathroom house with her adult daughter, Kelly, who will serve as a staff member, and two minor children (son, 15, and daughter, 4).

The home has 3 bedrooms, 2 bathrooms, and a kitchen, with a studio located on the bottom level of the home. The studio and top story are both listed as off-limits areas. LPA inspected the entire home, including the off-limit areas, for health and safety hazards. The home was clean and in order, the temperature and lighting were adequate, and the toxins and harmful items were made inaccessible to the children.

The home has 3 fully charged 2A10BC fire extinguishers, two working cellular phones, a land-line, two working smoke and carbon monoxide detectors, and first aid supply kit available. LPA inspected first aid supply kit to confirm all needed supplies. The Licensee covered all the electrical outlets. The home does not have a fireplace. The Licensee has a diaper-changing table available located in the daycare area and plans on purchasing and furnishing 3 cribs for infants to sleep in. Licensee will hold infants during bottle feedings. Licensee reports that parents will provide all diapers and wipes, and those items will be stored in each child’s daycare box. Licensee showed LPA children’s daycare boxes for personal items once enrolled. Licensee showed LPA nap-mats and tight-fitting sheets for infant crib and toddlers. Daycare is equipped with Infant feeding chair and one toddler table for children to eat snacks and lunch. Per Licensee, parents of infants will provide bottles and infant formula, and Licensee will wash and return bottles to parents when they pick their child up at the end of the day but will recommend to families to leave at least one box of formula per enrolled infant at daycare.

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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Yasha Nasiripour
LICENSING EVALUATOR SIGNATURE: DATE: 02/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2024
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 3
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: GONZALEZ, HASSEL
FACILITY NUMBER: 384004836
VISIT DATE: 02/06/2024
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Per the Licensee, they have no guns, weapons in the home. Licensee reports they have one service dog and have provided documents confirming that the dog is a registered service animal. Per the Licensee, she will provide breakfast, lunch, afternoon snack, and milk to all enrolled children, but will allow families to bring in their own snacks and lunches for their children. Licensee reports they have created a monthly menu and provide it to families, in case their children have any food allergies or dietary restrictions. Licensee will also provide drinking water from bottled water to fill up each child's personal cup brought from home. Licensee has spare toddler cups in case any families forget their child's personal water bottle.

Licensee reports that hours of operation are Monday - Friday, from 8:00am - 5:00pm.

Criminal Record Clearance - Licensee was reminded that all adults 18 and over living or working in home, 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, 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.

Safe Sleep - LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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: https://www.ada.gov/resources/child-care-centers/.

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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Yasha Nasiripour
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2024
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: GONZALEZ, HASSEL
FACILITY NUMBER: 384004836
VISIT DATE: 02/06/2024
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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-care-licensing/subscribe and select the Child Care option to receive email communication.

MyChildCarePlan.org – Licensee was informed of the MyChildCarePlan.org website; 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.

Megan’s Law - Family Child Care Homes
On this date, 02/06/2024, 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.

Review of records to be maintained - Family Child Care Homes
LPA reviewed with Licensee 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.

APPLICANT OWNS THE HOME:
The applicant provided proof of control of property.

The following items must be completed before licensure:
Install childproof locks on all drawers in the kitchen, refrigerator, and oven.
Install childproof locks on toilet seat and drawers in bathroom.
Install child safety gate in outdoor play area walk-way that leads to exit-gate
Formally closing license to previous FCCH.

Exit Interview - Exit interview conducted, and report was reviewed with the Licensee Hassel Gonzalez.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Yasha Nasiripour
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2024
LIC809 (FAS) - (06/04)
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