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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004876
Report Date: 05/23/2024
Date Signed: 05/23/2024 04:03:59 PM

Document Has Been Signed on 05/23/2024 04:03 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:GARCIA GUZMAN, MARIAFACILITY NUMBER:
384004876
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
05/23/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Maria Elena Garcia GuzmanTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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On 5/23/2024 at 1:00PM., Licensing Program Analyst (LPA), Luis Gomez and met with Licensee, Maria Elena Garcia Guzman. The purpose of today’s inspection was explained and was for an Announced; prelicensing inspection for change of location. Licensee's previous license is #384004876. Present was licensee and assistants. The licensee’s home is a 4 bedroom, 3 bathroom, 2 level house. Per licensee, days and hours of operations are: Monday- Friday, 8:00AM.- 5:00PM. The area designated for child care are: Upper Level: Living Room (Playroom/ Napping Area); Dining Room (Playroom #2); and Bathroom #1. The areas designated as off-limit are: Upper Level: Kitchen; Bedroom #1; Bedroom #2; Bathroom #2; Entire Ground Level: Backyard; Garage; Kitchen #2; Bedroom #3, Bedroom #4; and Bathroom #3. LPA inspected home with licensee for health and safety hazards.

At 1:10PM., the following was observed: Home was clean, neat, with a variety of playthings available. Floors and ground surfaces were clear of any obstructions or hazards. Children’s furniture, toys, and books inspected are in like-new condition. Licensee has tables and chairs are scaled to the proper size. Bathroom #1 was clean with fixtures in operating condition. The off-limit areas had been made inaccessible with safety gates. Windows and fireplace in playroom #1 have been barricaded. Home has ventilation, lighting, and was a comfortable temperature.

For nap services, LPA observed a play pen and several mats made from cleanable plastic material. Licensee has a functioning cell phone service, smoke/ carbon monoxide combination detector; and fully charged fire extinguisher (2A:10BC). Detergents; toxins; cleaning compounds; and items which could pose a danger have been stored in the off-limit areas.

Home does not have pools, fishponds, spas, jacuzzi or any other bodies of water. (REFER TO 809C, FOR CONT.)
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 05/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/23/2024
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: GARCIA GUZMAN, MARIA
FACILITY NUMBER: 384004876
VISIT DATE: 05/23/2024
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(PAGE 2)
At 1:50PM. LPA and licensee reviewed the ‘Records to Keep in Your Family Child Care Home’ (LIC311D), which includes the Children's Forms/ Records; Facility Forms; and Information to be Posted.

The licensee’s ‘Cardiopulmonary Resuscitation / First Aid’ certification is current, expiring: 7/2024.


The ‘Mandated Reporter Training’ (AB1207) proof of completion is current, expiring on: 7/19/2025.

Required postings are posted in visible location, and include the: Notification of Parent Rights (PUB369) and Emergency Disaster Plan (LIC610).

Per licensee, she plans to provide snacks and meals for children in care. Per licensee, isolation of an ill child will be in playroom.

Licensee was informed that the Department must be notified prior to the use of designated off-limits areas. LPA and the licensee discussed licensing regulations and the capacity requirements. Any children under 10 years of age will be counted in the capacity. Licensee was advised that all food containers brought from home must be properly stored and labeled. Licensee understands the required emergency disaster drills are to be conducted and documented every six months. Licensee understands that the use baby walkers, bouncers, jumpers and similar items are not to be used for children in care. Smoking is prohibited inside a Family Childcare Home.

Licensee was informed 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 for influenza, pertussis and measles or qualifies for an exemption pursuant to Health and Safety Code 1596.7995 and 1597.662.

Licensee was informed that all adults 18 years and over, living or working in the home, including employee and volunteers, 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 up to $500.00 maximum per day/ per person will be assessed if this regulation is violated.
(REFER TO 809C, FOR CONT.)
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2024
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: GARCIA GUZMAN, MARIA
FACILITY NUMBER: 384004876
VISIT DATE: 05/23/2024
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LPA discussed the safe sleep regulations with licensee and discussed Child Care Licensing Safe Sleep Web page at:https://www.cdss.ca.gov/inforesource/child-care-licesning/public-information-and-resources/safe-sleep as an additional resource. LPA informed licensee of the importance of checking for recalled infant devices on United States consumer Product Safety Commission (CPSC) website at http://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 with licensee. For IMS information, please see PIN 20-02-CCP. When an IMS is provided, a plan for 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- 0382 (TTY) and link to publications: Commonly asked questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

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 communication platform.


To receive important licensed- related information to licensed facilities, visit the CCLD important information website at https://www.cdss.ca.gov/infosource/community-care-licensing/subscribe and select the child care option to receive email communication.

During inspections, license submitted proof of immunization and LIC9108.

Prior to recommendation for approval of change in location, licensee must complete the following:
-Submit Proof of Control of Property to the Department
-Completed Earthquake Preparedness Checklist (LIC9148)
-Finish Moving into New Address

Exit interview and report was conducted with Licensee, Maria Elena Garcia Guzman and copy of this report was provided. This report will be kept in the facility file and made available for public review upon request. Desk Duty is available Monday- Friday between 8:00AM – 5:00PM at (650) 266 -8800.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2024
LIC809 (FAS) - (06/04)
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