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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414000100
Report Date: 01/06/2025
Date Signed: 01/06/2025 03:08:37 PM

Document Has Been Signed on 01/06/2025 03:08 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:NAVA, PAULETTE & RICHARDFACILITY NUMBER:
414000100
ADMINISTRATOR/
DIRECTOR:		NAVA, PAULETTE & RICHARDFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 346-2393
CITY:SAN MATEOSTATE: CAZIP CODE:
94403
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 0DATE:
01/06/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:10 PM
MET WITH:Paulette NavaTIME VISIT/
INSPECTION COMPLETED:
03:40 PM
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On January 6th, 2025, at approximately 1:10 PM, Licensing Program Analyst (LPA) Janet Gil conducted an unannounced, annual inspection. LPA met with licensee, Paulette Nava, and explained the purpose of the inspection. Present during LPA’s visit included licensee, spouse, and adult child. There were no children present during today's inspection. Per licensee, all enrolled children are on break and only there for a morning portion. Per licensee, she currently has 12 enrolled children. The licensee is a large license and is operating within capacity limits and ratio.

Licensees own home, which is a 3 bedrooms, 3 bathroom, multi level house. Licensee lives in home with spouse. All adults living and working in the home have fingerprint clearance. Licensee operates an after school program for children over the age of five. Per licensee, she operates a Montessori Program in two separate groups. The first group is with Kindergarteners from approximately 12:30 PM to 3:00 PM. The second group occurs with older school age children from approximately 3:00 PM to 6:00 PM.

Day Care Areas: Living Room, Dining Room, Garage (playroom), Bathroom #1 (at the end of the hallway), Bathroom #2 (located in dining room), Front Yard, Side Yard and Backyard.

Off-Limit Areas: the entire second level of the home, bedrooms located on first level of the home, and kitchen. All off limit areas are properly barricaded with child safety gates and/or locked doors.

At approximately 1:40 PM, LPA toured day care areas of home with licensee. LPA observed the home to be in repair with proper temperature and ventilation. LPA observed an enclosed fireplace in living room. Home is equipped with a variety of toys and materials that were observed to be in working condition. LPA observed a fully stocked accessible first aid kit backpack located in the front entrance of the home. LPA did not observe any accessible cleaning supplies, poisons, and solutions in day care areas. LPA observed electrical outlets to be made inaccessible with outlet covers. Home is equipped with two fully charged fire extinguishers and a smoke and carbon monoxide detector. LPA tested carbon monoxide detector in hallway area near off-limit office bedrooms, which was observed to be working. Per licensee, they also have an installed sprinkler system, and implemented pull fire alarm. Licensee has one child with allergies, who has an epi-pen. Per licensee, child is school age and medication is stored in staff backpack. Per licensee, she provides snack only for children in care.

At approximately 2:15 PM, LPA observed bathroom for children's use was in proper working condition. LPA observed bathroom to include appropriate toileting equipment and sanitation products. LPA did not observe any hazardous materials to be accessible to children in the bathroom.

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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Janet Gil
LICENSING EVALUATOR SIGNATURE: DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/19/2024
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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: NAVA, PAULETTE & RICHARD
FACILITY NUMBER: 414000100
VISIT DATE: 01/06/2025
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The entire backyard is fully enclosed. The outdoor area is equipped with a variety of toys and materials. LPA observed a built in Outdoor play structure and an enclosed chicken coop in the back yard. LPA observed glass enclosed fish pond in front yard area. Per licensee, children are only allowed to read in area near fish pond.

LPA reviewed five children records which were complete. The children’s files have a record of emergency identification information on file. LPA reviewed staff records for licensee which were complete. Licensee's CPR/FIrst Aid is current and will expire 9/2026. The licensee’s Mandated Reporter training certification is also current and will expire 09/2026. The licensee also has required immunization available for both liceness. LPA reminded licensee that assistant staff must also have required immunization records on file and available for inspections.

Licensee has licensing documentation properly posted and available for review. The licensee also maintains a childcare roster that was made available for review. Emergency disaster drills are conducted at least once every six months. The last disaster drill was conducted on December 16th, 2024. Per licensee, 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.

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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Janet Gil
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2025
LIC809 (FAS) - (06/04)
Page: 2 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: NAVA, PAULETTE & RICHARD
FACILITY NUMBER: 414000100
VISIT DATE: 01/06/2025
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LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://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.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. 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 are available at: https://www.ada.gov/resources/child-care-centers/.

On this date, 1/3/2025, 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.

During the exit interview, the licensee, Paulette Nava, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

No deficiencies were cited today under CCR, Title 22, Div. 12, Chapt. 1.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Paulette Nava.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Janet Gil
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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