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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414000300
Report Date: 11/16/2023
Date Signed: 11/16/2023 03:29:22 PM

Document Has Been Signed on 11/16/2023 03:29 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:AGUADO, SUSAN & CARMICHAEL, CHRISTINEFACILITY NUMBER:
414000300
ADMINISTRATOR:S. AGUADO & C. CARMICHAELFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 572-2411
CITY:SAN MATEOSTATE: CAZIP CODE:
94402
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 7DATE:
11/16/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:38 PM
MET WITH:Christine Carmichael TIME COMPLETED:
03:40 PM
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On 11/16/2023 at 2:38PM., Licensing Program Analysts (LPA) Luis J. Gomez met with Licensee, Christine Carmichael. Purpose of the inspection was explained and was for an unannounced, plan of correction inspection established on 11/2/2023. Present was the licensee and helper caring for 7 children (4 infant, 3 preschool age). LPA inspected facility with licensee for health and safety hazards.

During inspection, LPA conducted record review, observations and interviewed the licensee.

LPA observed licensee operating within required capacity limit stated on license, with 7 children; 4 infants in care. Licensee submitted updated children’s schedule to the department via email.

LPA reviewed the children’s and facility records. LPA confirmed the ‘Infant Sleeping Plan (LIC9227), has been stored in C1’s file. Children’s records contained the required LIC9224, signed by the authorized representatives.

Licensee’s ‘Mandated Reporter Training’ certification had been updated, expiring: 11/12/2025.

Deficiency issued on 11/2/2023, have been cleared, and ‘Cleared Plan of Correction Letters’ provided.

Based on today's inspection, no deficiencies were observed in the areas evaluated according to the Title 22 Division 12 Code of Regulations. Exit interview, and report was discussed with Licensee, Christine Carmichael. Signature of this form acknowledges receipt of these documents.

This report must be available in the facility for public review. Notice was provided and shall remain posted for 30 days. Licensee was advised for additional questions to call CCL Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2023
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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