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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414001409
Report Date: 01/04/2024
Date Signed: 01/04/2024 04:25:06 PM

Document Has Been Signed on 01/04/2024 04:25 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:DIAZ, MARIA BETTINA C.FACILITY NUMBER:
414001409
ADMINISTRATOR:DIAZ, MARIA BETTINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 579-2678
CITY:SAN MATEOSTATE: CAZIP CODE:
94401
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
01/04/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Licensee, Maria DiazTIME COMPLETED:
04:30 PM
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On 1/4/2024, at approximately 2:45PM, Licensing Program Analyst (LPA) Jonathan Tse conducted an unannounced annual visit at the facility. LPA was granted entry to the facility by Licensee, Maria Diaz. LPA explained the purpose of the visit. Present during the visit was the Licensee, two preschool age children and one infant. The facility is in compliance with capacity requirements on this day. All adults working or living in the home have acquired fingerprint clearance and are associated to the facility. The facility’s operating hours are from 7:30AM to 5:30PM, Monday to Friday.

Daycare Areas: Living Room, Kitchen/Dining Room, Bathroom #1, Backyard, and a pass-through section of the Garage.
Off-limits Areas: Bedroom #1, Bedroom #2, Bedroom #3, Bathroom #2, and Garage.

LPA inspected the home for any health and safety hazards. LPA observed the Living Room to be equipped with age-appropriate toys and learning materials. There are mats and cribs available for children to nap in. Parents provide bedding and take them home once a week for cleaning. There is a fully charged 3A40BC fire extinguisher present in the Kitchen. There is a combination smoke and carbon monoxide detector present in the Living Room. There are two first aid kits, one in the Kitchen and another in the Garage pass-through area. LPA observed first aid kits to be fully stocked and accessible. All electrical outlets were observed to either be covered or obstructed by furniture to be inaccessible to children. There is a fireplace in the Living Room that is obstructed by furniture to be inaccessible to children in care. All cabinets and drawers in the Kitchen are secured by childproof locks. Per Licensee, there are no firearms or weapons located in the facility.



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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE: DATE: 01/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/04/2024
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: DIAZ, MARIA BETTINA C.
FACILITY NUMBER: 414001409
VISIT DATE: 01/04/2024
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All off-limits areas are barricaded or secured to be inaccessible to children in care. The pass-through section of the Garage is clearly separated from the rest of the Garage by childproof gates. All stairs are secured by gates or other barricades. The Backyard was observed to have multiple age-appropriate play structures and toys available for children. The play equipment is in working condition. The Backyard is enclosed by a fence that is at least five feet high. There is sufficient cushioning in the form of woodchips. There is a shed located in the Backyard that is used for storage and is kept locked.

LPA reviewed Licensee’s file and three children’s files. Licensee’s First Aid/CPR training expires 4/2024, and their Mandated Reporter Training expires 1/2026. Licensee is aware of requirement to renew those trainings every two years. All children’s files were found to be complete and included Identification and Emergency Information (LIC700) and Consent for Emergency Medical Treatment (LIC627). Infant sleep logs were available for review and upon review, were found to be complete for all infants in care.

LPA observed all required postings to be posted in a visible and accessible area of the Living Room. Postings included the facility license, Emergency Disaster Plan (LIC610A) and Notification of Parents’ Rights (PUB394). The facility provides breakfast, lunch and snack to children in care.

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: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024
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: DIAZ, MARIA BETTINA C.
FACILITY NUMBER: 414001409
VISIT DATE: 01/04/2024
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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-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.

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/.

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, Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

No deficiencies cited during today's visit.
A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Maria Diaz.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024
LIC809 (FAS) - (06/04)
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