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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004963
Report Date: 01/10/2025
Date Signed: 01/10/2025 11:19:23 AM

Document Has Been Signed on 01/10/2025 11:19 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:FUENTES PAREDES, KIMBERLYFACILITY NUMBER:
384004963
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 6TOTAL ENROLLED CHILDREN: 6CENSUS: 0DATE:
01/10/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:40 AM
MET WITH:Kimberly Fuentes ParedesTIME VISIT/
INSPECTION COMPLETED:
11:35 AM
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On January 10, 2025 @ approx. 8:40 am, Licensing Program Analyst (LPA) Maria Olguin-Leon, conducted an announced, pre-licensing inspection visit. LPA met with Kimberly Fuentes Paredes and explained the purpose of the inspection. Applicant submitted a small childcare home application to our department on November 12, 2024. Hours of operation will be Monday-Friday 8:00 am – 5:00 pm. Applicant plans to provide care to children ages 0 months to 5 yrs. old. Applicant lives in apartment with spouse and one minor child. Present during today’s visit was applicant and applicant’s mom. All adults living in home have criminal background clearance.

With applicant, LPA inspected the indoors of the home for health and safety hazards. Applicant rents apartment that consists of a living room, dining room, kitchen, two small hallways, 2 bedrooms, 2 bathrooms, and outdoor patio. The DAY CARE AREAS: are the living room (playroom), bedroom #2, bathroom #2, both hallways. The OFF-LIMIT AREAS: kitchen, dining room, master bedroom, master bathroom, and outdoor patio. Applicant was notified any off-limit areas are not to be used as a day care area without prior approval from department.

LPA observed the following: Apartment was clean and orderly. Living room (daycare room) is equipment with plenty of age-appropriate toys, highchairs, ball pit, wood climbing structures, toy storage cubbies, and child size furnishing. Bedroom #2 is equipped with playpens, sleeping cots and a changing table. LPA reminded applicant to clean and disinfect table after diapering children. Applicant will provide sheets for playpens and will wash weekly. Childproof retractable gates are located at kitchen and dining room entrances and in hallway. Bathroom cabinets and hallway closets are equipped with childproof locks. All electrical outlets are properly covered with child proof covers and furniture. Sliding glass door into patio is equipped with a lock and screen door. Living room floor is equipped with foam mats to cushion falls. LPA did not observe any spas, pools, or bodies of water. Per applicant, applicant plans to use outdoor patio once patio is set up for children in care.

Apartment has proper ventilation and lighting throughout. All detergents, cleaning compounds, medications and other items which could pose a danger are stored inaccessible to children behind child safety locked cabinets and/or located in off limit areas. Per applicant, there are no weapons or firearms in the home.

Cont. page 2...
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE: DATE: 01/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/10/2025
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 4
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: FUENTES PAREDES, KIMBERLY
FACILITY NUMBER: 384004963
VISIT DATE: 01/10/2025
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Apartment is equipped with a working dual carbon monoxide/smoke detector. A fully charge fire extinguisher 3-A:40 B:C is located on living wall and easily accessible. LPA observed a first aid kit fully stocked with necessary supplies. Applicant uses a designated cell phone and is aware the cell phone must stay within the home during the day care hours. Isolation area for sick children will be in hallway and away from other children and where applicant can supervise all children in care. Applicants discipline techniques will include talking to children and redirection.

LPA reviewed the LIC311D, Records to Keep in Your Family Childcare Home, children’s forms/ records, facility forms, and information to be posted. Entrance Checklist was provided to the applicant. Applicant’s CPR/First Aid certification expires 09/2026. Applicants Mandated Reporter training certificates (AB1207) is current that will expire 09/2026. LPA observed all required licensing documents posted on living room wall; emergency disaster plan (LIC610A), Parent right’s poster, Earthquake preparedness (LIC9148), and Facility Sketch with evacuation route.

LPA and applicant discussed licensing regulations and the capacity requirements. Any children under 10 years of age that live in the home, will be counted in overall capacity. LPA reminded applicant they must be present in home 80% of operating hours. Applicant plans to provide two meals and two snacks to children in care. LPA discussed sanitation and allergies with applicants. LPA reminded Applicant to label all food brought from home.

Applicant understands the required emergency disaster drills are to be conducted and documented at least once every six months. Applicant understands that the use of baby walkers, bouncers, jumpers, and similar items are not to be used for children in care. Smoking is prohibited inside a Family Childcare Home.

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, 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.



Cont. page 3...
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2025
LIC809 (FAS) - (06/04)
Page: 4 of 4
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: FUENTES PAREDES, KIMBERLY
FACILITY NUMBER: 384004963
VISIT DATE: 01/10/2025
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The applicant has not obtained a signed Property Owner/Landlord Consent form (LIC9149). Without this consent, the applicant 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 applicant 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.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. 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

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 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.

On this date, 11/18/2024, 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.

Cont. page 4...
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2025
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: FUENTES PAREDES, KIMBERLY
FACILITY NUMBER: 384004963
VISIT DATE: 01/10/2025
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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

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

Small Family Childcare License is approved and will be effective as of today, January 10, 2025.

Exit interview conducted and report was reviewed with the applicant, Kimberly Fuentes Paredes. Visit was conducted and translated in Spanish.

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2025
LIC809 (FAS) - (06/04)
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