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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414001369
Report Date: 10/24/2023
Date Signed: 10/24/2023 03:56:32 PM

Document Has Been Signed on 10/24/2023 03:56 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:HERNANDEZ, ROSARIO INGRIDFACILITY NUMBER:
414001369
ADMINISTRATOR:HERNANDEZ, ROSARIO INGRIDFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 229-3798
CITY:SAN CARLOSSTATE: CAZIP CODE:
94070
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 8DATE:
10/24/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Rosario HernandezTIME COMPLETED:
04:20 PM
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On October 24, 2023 @ approx. 1:35 PM, Licensing Program Analyst (LPAs) Maria Olguin-Leon and Jonathan Tse met with Licensee, Rosario Hernandez for an unannounced annual inspection. The purpose of the inspection was explained. Present today was Licensee, helper, two fingerprinted adults listed on guardian, and 8 children (4 infant and 4 preschool age). All adults working at facility have fingerprint clearance. LPA observed facility is operating within capacity limits. Hours of operation are Monday– Friday, 8:00 am - 5:00pm.

LPAs and Licensee toured the home for health and safety hazards. Day Care Areas: Entryway, living room, Kitchen (walk through area and for highchairs only), bathroom, Bedroom #1 (napping only), Playroom and backyard. Off Limits Areas: Kitchen, Bedroom #2 and #3, and garage. Playroom is barricaded with a child proof gate. Fireplaces is in off limits area and is properly barricaded. Home is well light and has proper ventilation. Cleaning supplies and other potentially harmful items are stored inaccessible to the children. All electrical outlets are secured with child proof covers. There are plenty of age-appropriate toys, books, child size furnishings, learning material, and playpens. Playroom flooring is foam mats to cushion falls. Backyard has plenty of age-appropriate play toys, play structure, and ride on toys all in good condition. Play structure is on cement patio and equipped with rubber floor padding to cushion falls. There is a short white gate separating patio play area from grass play area. Backyard is surrounded with a 5 ft. fence. There are no spas, pools, or other bodies of waters.

Home is equipped with a working dual carbon monoxide/smoke detector and a fully charged fire extinguisher. Isolation area for ill children will be in walk through area of kitchen and away from other children and supervised. First aid kit is fully stocked with supplies. Licensee uses a cell phone on the premises. Per licensee there are no weapons or firearms in the home. Licensee provides sheets for playpens and are washed weekly or when soiled. LPAs discussed the importance of documenting sleeping logs for children under the age of 2. .

Cont. page 2…
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE: DATE: 10/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/24/2023
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 6
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: HERNANDEZ, ROSARIO INGRID
FACILITY NUMBER: 414001369
VISIT DATE: 10/24/2023
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LPAs reviewed 8 children’s records and 1 staff record. All children’ files are complete. LPA reviewed children's roster. Licensee CPR/FA expires 06/2024. Licensee Mandated Reporter training expires 07/2024. Licensee provides Breakfast, Lunch, and two snacks for children in care. LPA reminded Licensee to label children's food/bottles brought from home. LPA observed Childcare License, Emergency Disaster Plan (LIC610A) and Parent's rights. Last emergency drill was conducted on 06/2023 and properly documented. Per Licensee, Liability insurance is provided by Farmer's insurance.

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.

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/.

The Licensee was reminded about the Provider Information Notices (PINs) on the CCLD website. 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 against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.

As of January 1, 2018, all staff must complete Mandated Reporter Training every two years. LPA reminded licensee about Mandated Reporter training available www.mandatedreporterca.com. Helper mandated reporter has expired.

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

DATE: 10/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023
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: HERNANDEZ, ROSARIO INGRID
FACILITY NUMBER: 414001369
VISIT DATE: 10/24/2023
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LPA discussed the safe sleep regulations with Licensee 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. LPAs also informed licensee [or facility representative] 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. LPA reminded Licensee to keep sleep logs for all children under the age of 2 yrs old.

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 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 LICENSEE, Rosario Hernandez confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS on 10/23/2023.

No deficiencies were issued today under Title 22 Division 12 of the California Code of Regulations

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee, Rosario Hernandez.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023
LIC809 (FAS) - (06/04)
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