410504500-12-12-2023-05-CC-CQUO-CYG277-20231212160815

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 410504500
Report Date: 12/12/2023
Date Signed: 12/12/2023 04:08:22 PM

Document Has Been Signed on 12/12/2023 04:08 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:	CANESSA, ANGELA		FACILITY NUMBER:	410504500
ADMINISTRATOR:	CANESSA, ANGELA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 325-8373
CITY:	MENLO PARK	STATE: CA	ZIP CODE:	94025
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 7	CENSUS: 7	DATE:	12/12/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	02:20 PM
MET WITH:	Angela Canessa & Jeannie Gallagher		TIME COMPLETED:	04:45 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	On December 12, 2023 at approximately 2:20pm, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, annual inspection. LPA met with licensee, Angela Canessa, and explained the purpose of the inspection. Present in the home were licensee, licensee's helper (H1) and 7 enrolled children (4 infants and 3 preschool age). Licensee is a large license with an assistant present. Licensee is operating within capacity limits and ratio during LPA's visit. Licensee and H1 have fingerprint clearance on file. Licensee lives in the multi-level home. Hours of operation are Monday to Friday from 8:00am to 5:00pm. The DAY CARE AREAS are on the first level of the home that includes garage (converted into day care room), kitchen (pass by only), bathroom #1, nap room and backyard area. The OFF LIMIT AREAS are the entire second level of the home. All off limit areas are barricaded with child safety gates. LPA toured day care areas of home with H1. LPA observed home to be in good repair with proper temperature and ventilation. Home is equipped with a variety of toys and materials that were observed to be in good working condition. Electrical outlets are made inaccessible with child safety covers. LPA did not observe any chemicals or poisons in low cabinets and drawers in day care areas. Home is equipped with a fully charged fire extinguisher, multiple smoke detectors and multiple carbon monoxide detectors. LPA tested carbon monoxide detector in main day care area, which was observed to be working. Hallway bathroom utilized for children was observed to be clean. There is a diaper changing table in bathroom that is within arm's reach to a sink. Bathroom is equipped with appropriate toileting and sanitation products. LPA did not observe accessible chemicals in bathroom. (Continue Report on Page 2...)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023

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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Document Has Been Signed on 12/12/2023 04:08 PM - It Cannot Be Edited

Created By: Catrina Quimbo On 12/12/2023 at 03:11 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: CANESSA, ANGELA	FACILITY NUMBER: 410504500
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(j)(2)

Infant Safe Sleep

The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, record review, the licensee did not comply with the section cited above. Sleeping logs are not maintained for napping infants which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/12/2024
	Plan of Correction
1 2 3 4	LPA provided a sample sleeping infant chart. H1 stated they will document sleeping logs for infants that includes the 15 minute time check of when infants are checked on. LPA to conduct a follow up visit.

Type B

Section Cited

CCR

102416(c)

Personnel Requirements

(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observationm, interview, record review, the licensee did not comply with the section cited above. Licensee's CPR/First Aid certification expired as of 12/02/2023. H1 does not have proof of a current CPR/First Aid certification, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/12/2024
	Plan of Correction
1 2 3 4	H1 stated they will submit to LPA copy of their current CPR/First Aid certification. LPA to conduct follow up visit.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Marie Rodriguez

LICENSING EVALUATOR NAME:

Catrina Quimbo

LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023

LIC809 (FAS) - (06/04)

Page: 2 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: CANESSA, ANGELA	FACILITY NUMBER: 410504500
	VISIT DATE: 12/12/2023

NARRATIVE

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Nap room for children includes cribs. Per H1, both infants and children over 2 years old sleep in cribs. LPA observed some cribs to be empty, free of loose articles and objects while other cribs included blankets. LPA reminded H1 infants sleeping in cribs cannot have blankets, pillows or bumper pads. LPA reminded H1 sleeping logs must be maintained for every infant in care. During visit, LPA provided licensee and H1 with PIN 20-24-CCP of safe sleep regulations.

The backyard is enclosed with at least 5 ft high fence. Backyard is equipped with appropriate outdoor toys and equipment. LPA did not observe any pools, spas or bodies of water on the property.

LPA reviewed 7 children’s records. Children’s files have a record of emergency identification information. Licensee's CPR/First Aid certification expired as of 12/02/2023. Per H1, they have an updated certification, however, were unable to provide a copy to LPA during visit. LPA reminded H1 all staff working with children must have a current Mandated Reporter certification and must be renewed every two years.

Licensee has licensing documentation properly posted and available for review. Licensee also maintains a child care roster that was made available for review. Per H1, there are no weapons or firearms in the home.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at
www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Licensee was reminded that all adults 18 and over living or working in the 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.
(Continue Report on Page 3...)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023

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: CANESSA, ANGELA	FACILITY NUMBER: 410504500
	VISIT DATE: 12/12/2023

NARRATIVE

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LPA discussed the safe sleep regulations with H1 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 H1 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 22-02-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)/ (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/.

H1 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.

During the exit interview, the facility representative, Jeannie Gallagher, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Licensee was issued two Type B citations for not maintaining sleeping logs for napping infants and no staff on site having proof of a current CPR/First Aid certification.

A notice of site visit was given and must remain posted for 30 days. Appeal Rights were provided to H1.

Exit interview conducted and report was reviewed with the facility representative, Jeannie Gallagher.

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023

LIC809 (FAS) - (06/04)

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