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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414001759
Report Date: 12/12/2023
Date Signed: 12/12/2023 04:09:36 PM

Document Has Been Signed on 12/12/2023 04:09 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:CHAVEZ, MONICA & AVILES, MONICAFACILITY NUMBER:
414001759
ADMINISTRATOR:CHAVEZ, MONICA & AVILES, MFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 568-9845
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94061
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
12/12/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:TIME COMPLETED:
04:30 PM
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On December 12, 2023 @ approx. 1:25 PM, Licensing Program Analysts (LPA’s) Maria Olguin-Leon and Melissa Zaragoza met with Licensee, Monica Aviles for an unannounced annual inspection. The purpose of the inspection was explained. Present today was Licensee, two helper and 14 children (3 infant and 11 preschool age). All adults working at facility have fingerprint clearance. Licensee stated two other adults were present in home, both adults have fingerprint clearance. LPA observed facility is operating over capacity limits. This is an immediate risk to children in care. A type A violation is issued this day for this deficiency. Hours of operation are Monday– Friday, 7:00 am – 6:00pm.

LPAs and Licensee toured the home for health and safety hazards. Day Care Areas: Daycare room and bathroom and front yard. Off Limits Areas: Entire home and garage. Daycare room is enclosed and has a separate entrance from main home. Daycare room 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, playpens and sleeping mats. Daycare room has tile flooring and carpeting. Front yard has plenty of age-appropriate play toys, play structure, table, and ride on toys all in good condition. Play structure is surrounded with tanbark and yard has grass to cushion falls. Front yard is surrounded with a 5 ft. fence. There are no spas, pools, or other bodies of waters.

Home is equipped with a working carbon monoxide and smoke detector and a fully charged fire extinguisher. Isolation area for ill children will be outside in front yard 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. Parents provides sheets for sleeping mats and are washed weekly or when soiled. LPAs discussed the importance of having sleep logs available for LPAs to confirm 15-minute sleep check, Licensee understood and will document for all children under the age of 2 yrs. old.

Cont. page 2…
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE: DATE: 12/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/12/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: CHAVEZ, MONICA & AVILES, MONICA
FACILITY NUMBER: 414001759
VISIT DATE: 12/12/2023
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LPAs reviewed 6 children’s records and 3 staff record. All children’s record were complete. LPA’s reminded Licensee to include LIC9150 in children’s files if caring for more than 12 children. LPA reviewed children's roster. Licensee CPR/FA expires 04/2025. Licensee Mandated Reporter training expires 06/2024. Licensee provides Breakfast, Lunch, and two snacks to children in care. LPAs reminded Licensee to label children's food/bottles brought from home. LPAs observed Childcare License, Emergency Disaster Plan (LIC610A) and Parent's rights. Last emergency drill was conducted on 12/01/2023, per Licensee schedule, LPAs reminded Licensee to initial schedule for completion of emergency drill. Licensee carries Liability insurance with Accord and expires 06/2024.

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

Cont. page 3...
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023
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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: CHAVEZ, MONICA & AVILES, MONICA
FACILITY NUMBER: 414001759
VISIT DATE: 12/12/2023
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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. LPA discussed sleeping logs and ban of sleeping bags. LPA’s 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.

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, Monica Aviles confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS on 09/26/2023.

**See following page for deficiencies cited against the facility today under CCR, Title 22, Div. 12, Chapt. 1**

Type “A” violation was issued today. Licensee is advised to provide a copy of the Evaluation Report and all Type “A” Deficiencies cited, to the parents and guardians of children currently enrolled in care and to parents of newly enrolled children during the next 12 months. A signed and dated LIC 9224 shall be maintained in all Children's files.

Cont. Page 4...
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023
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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: CHAVEZ, MONICA & AVILES, MONICA
FACILITY NUMBER: 414001759
VISIT DATE: 12/12/2023
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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, Monica Aviles.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023
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Document Has Been Signed on 12/12/2023 04:09 PM - It Cannot Be Edited


Created By: Maria Olguin-Leon On 12/12/2023 at 03:58 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: CHAVEZ, MONICA & AVILES, MONICA
FACILITY NUMBER: 414001759

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102416.5(a)
Staffing Ratio and Capacity
(a) The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review], the licensee did not comply with the section cited above. LPA confirmed Licensee is operating overcapacity with 3 infants and 11 preschooler in care, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 12/13/2023
Plan of Correction
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Licensee will discuss with parents and terminate or reschedule children to another day POC date to be in compliance and will submit new roster and children's schedule to LPA.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Marie Rodriguez
LICENSING EVALUATOR NAME:Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:
DATE: 12/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/12/2023


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