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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004865
Report Date: 05/02/2024
Date Signed: 05/02/2024 06:01:34 PM

Document Has Been Signed on 05/02/2024 06:01 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:RODRIGUEZ, ANA SARAFACILITY NUMBER:
384004865
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
05/02/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:40 PM
MET WITH:Ana Sara RodriguezTIME VISIT/
INSPECTION COMPLETED:
05:45 PM
NARRATIVE
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On May 2, 2024., Licensing Program Analyst (LPA) Van conducted a pre-licensing relocation inspection and met with the Licensee, Ana Sara Rodriguez. The Licensee has requested to move from her previous location, which was # 384004463, to the present location. Additionally, the licensee requested an increase in capacity from 6 to 12. The licensee rents this townhouse unit, which has two bedrooms and a bath. Per the Licensee, the home's residents are herself, her husband, and two minors. Upon entering the house, LPA observed the Licensee was supervising two preschool-age children. Both children are the licensee’s sons.

The licensee plans to use the following areas for childcare: the living room, kitchen, dining room, and bedroom #2. The off-limit areas are bedroom #1/licensee bedroom, as well as both upstairs and downstairs closets.

LPA and the Licensee inspected the entire home for Health and Safety Hazards. The house is well-organized and clean and has sufficient lighting and air circulation. A fully charged fire extinguisher with the specification of 3A 40 BC is readily available. The licensee has installed several carbon monoxide and smoke detectors in the unit. During the inspection, the carbon monoxide and smoke alarms were tested and found to be operational. All harmful, sharp, and toxic objects are stored out of children's reach and made inaccessible. LPA reminded the licensee to install child-proof latches/locks on kitchen drawers and cabinets for safety.

LPA noticed that the home is well-equipped with various toys and reading materials suitable for children of different ages.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE: DATE: 05/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/02/2024
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: RODRIGUEZ, ANA SARA
FACILITY NUMBER: 384004865
VISIT DATE: 05/02/2024
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According to the Licensee, there are no guns or weapons on the premises, and no pets.

The licensee stated that she intends to utilize the shared community backyard to create a play area for the children under her care. However, as the yard lacks a fence, LPA has advised the Licensee to be vigilant at all times and position herself so that she has the best view of all children when they are outside. In addition, the Licensee has informed LPA that she intends to take the children to the nearby public park for further outdoor activities.

LPA reviewed with the Licensee the LIC 311D, Forms/Records to Keep in Your Family Child Care Homes, children's forms/records, facility forms/records, and all required postings such as License/Parent's Right poster/Emergency Disaster Plan and Earthquake Preparedness checklist. In addition, the entrance Checklist was also provided to the Licensee. License capacity and limitation were also reviewed with the Licensee. LPA informed the Licensee that if care is provided to the 13th and 14th child, who must be school-aged, parent notification and landlord consent are required.

LPA discussed the safe sleep regulations with the Applicant and discussed the Child Care Licensing Safe Sleep webpage https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed the Applicant 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.

The Licensee 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, 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.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2024
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: RODRIGUEZ, ANA SARA
FACILITY NUMBER: 384004865
VISIT DATE: 05/02/2024
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The licensee has not obtained a signed Property Owner/Landlord Consent form (LIC9149). Without this consent, the licensee understands that, once licensed, they can operate with a maximum capacity of 6 [or 12] children. If property owner/landlord consent is obtained in the future, the licensee is advised that a new Application for a Family Child Care Home License (LIC 279) must be submitted with a change of capacity fee of $25, to increase the capacity and provide care to 8 [or 14] children.

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) or (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.

The licensee was reminded that as of September 1, 2016, a person may not be employed or volunteer at a childcare facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety Code 1596.7995 and 1597.662. The licensee was encouraged to obtain a copy of regulations and current licensing forms through the Department's website at www.ccld.ca.gov. The licensee was also reminded of Mandated Reporter Online Training for Child Care Providers (AB 1207) and the additional General Training, and both are available on www.mandatedreporteca.com.

On this date, 4/18/2024, 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.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2024
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: RODRIGUEZ, ANA SARA
FACILITY NUMBER: 384004865
VISIT DATE: 05/02/2024
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Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders through 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.

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

The licensee’s home will be recommended for a Large FCCH license once the following issues are addressed:

· Licensee needs to install child-proof stove knobs for the stove in the kitchen.
· Installing a soft cushion at the edge of the stairs to create a safer environment.
· Purchase of First Aid kits
· Submit complete document for the control of the property.
· Approval fire clearance from the San Francisco Fire Department.

Exit interview conducted and report was reviewed with the applicant, Ana Sara Rodriguez.

Today's report was provided to the licensee. This report will be kept in the facility file and available for public review upon request. Desk duty is available Monday - Friday, 8:00 a.m. – 5:00 p.m. (650) 266-8800. Website for Forms and Regulations: www.cdss.ca.gov
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2024
LIC809 (FAS) - (06/04)
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