414001725-8-21-2023-05-CC-ACON-CUWSHC-20230821135320

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414001725
Report Date: 08/21/2023
Date Signed: 08/21/2023 01:53:26 PM

Document Has Been Signed on 08/21/2023 01:53 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	TEMPORARY TOT TENDING		FACILITY NUMBER:	414001725
ADMINISTRATOR:	GAUTHIER, BRIGETTE		FACILITY TYPE:	840
ADDRESS:	1283 TERRA NOVA BOULEVARD		TELEPHONE:	(650) 355-5026
CITY:	PACIFICA	STATE: CA	ZIP CODE:	94044
CAPACITY: 100	TOTAL ENROLLED CHILDREN: 100	CENSUS: 26	DATE:	08/21/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Brigette Gauthier		TIME COMPLETED:	02:07 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 August 21, 2023 at 9:30 AM, Licensing Program Analyst (LPA) Cowan met with director, Brigette Gauthier for a 1 Year Required Inspection. Purpose of the inspection was explained. Present, in the facility is director, 4 staff, and 26 children in care. Facility is operating within its capacity, and facility is in compliance with staff / child ratio on this day. Facility operates day care Monday to Friday from 07:30 AM to 5:30 PM. With director, LPA inspected the day care room and play yard. LPA observed facility has working smoke detector, carbon monoxide detector, fully charged fire extinguisher, and working telephone on site. All cleaning solutions, poisons and other chemicals dangerous to the children are stored inaccessible to the children. Facility has age -appropriate furniture. Facility floor is in good repair and free of any hazards. There are first aid supplies available in the classroom. All bathrooms are in working condition. Play yard is free of hazards. There is a sufficient amount of poured to help absorb the impact of falls. There is water available on the yard as well as in the classroom. LPA observed that facility is using electronic sign in / out. Facility has license and all other required documents posted and visible for the public. Facility’s last emergency drill was conducted 7/28/23 and is properly logged. At 12:42 PM, LPA reviewed the facility records. LPA reviewed 5 random children files and 5 staff files. Facility files are complete with all required Licensing documents. Per director, all contact information of file is current. 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. Report continues ....

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: April Cowan
LICENSING EVALUATOR SIGNATURE:	DATE: 08/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: TEMPORARY TOT TENDING	FACILITY NUMBER: 414001725
	VISIT DATE: 08/21/2023

NARRATIVE

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Site director was reminded that all adults 18 and over, 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 Child Care Center. 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.

LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP. CCC COMPLETED TESTING AND IS IN THE PROCESS OF REMEDIATING LEAD EXCEEDANCES. The exceedance is a potential risk to children in care and a Type B citation is issued for this deficiency.

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-carecenters/.

Site director 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.

Exit interview conducted and report was reviewed with the site director, Brigette Gauthier..
A notice of site visit was given and must remain posted for 30 days.

>See next page for deficiencies

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: April Cowan
LICENSING EVALUATOR SIGNATURE:	DATE: 08/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 08/21/2023 01:53 PM - It Cannot Be Edited

Created By: April Cowan On 08/21/2023 at 01:24 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: TEMPORARY TOT TENDING	FACILITY NUMBER: 414001725
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/21/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

101700.3(b)(1)

101700.3 California Lead Action Level at Child Care Centers (b)(1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on (record review), the licensee did not comply with the section cited above in one sink in the facility has an exceedance which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/21/2023
	Plan of Correction
1 2 3 4	Site director agrees to have testers upload results, and have fixture with exceedance retested.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Garfield Leung

LICENSING EVALUATOR NAME:

April Cowan

LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2023

LIC809 (FAS) - (06/04)

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