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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414001759
Report Date: 12/04/2024
Date Signed: 12/04/2024 03:00:18 PM

Document Has Been Signed on 12/04/2024 03:00 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/
DIRECTOR:		CHAVEZ, MONICA & AVILES, MFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 568-9845
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94061
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
12/04/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:24 AM
MET WITH:Monica AvilesTIME VISIT/
INSPECTION COMPLETED:
03:20 PM
NARRATIVE
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On December 4, 2024, at approximately 9:30pm, Licensing Program Analysts, (LPAs) Maria Olguin-Leon and Melissa Zaragoza conducted an unannounced visit and met with Licensee, Monica Aviles. Present during today's visit was both licensees, 2 helpers, and 11 children (1 infant and 10 preschoolers).

During visit conducted on October 11, 2024, LPAs collected children’s rosters. LPAs determined rosters were not updated and were missing names and information for enrolled children, including siblings. As this poses a potential health and safety hazard a type “B” deficiency is being issued.

At approximately 9:35 am today, LPAs observed an infant sleeping on a mat with a blanket over their face. LPAs reminded licensee of safe sleep regulations and the importance of placing infants in cribs while infants are sleeping. LPAs also reminded licensee that an infant’s head shall not be covered while sleeping. Due to these observations, two type “B” deficiencies are being cited today, as these pose a potential health and safety hazard.

Safe sleep regulations were discussed with Licensee, Monica Aviles and LPAs provide licensee with PIN 20-24-CCP.

See page LIC9099D for three type “B’ deficiencies being issued today, under California Code of Regulations, (Title 22, Div. 12,).

An exit interview was conducted with licensee, Monica Aviles. Appeal Rights were provided.

Notice of Site Visit shall remain posted for 30 days. Failure to maintain posting as required, will result in an immediate $100 civil penalty. This report is public and can be reviewed.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE: DATE: 12/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/04/2024
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 3
Document Has Been Signed on 12/04/2024 03:00 PM - It Cannot Be Edited


Created By: Maria Olguin-Leon On 12/04/2024 at 11:53 AM
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: 12/04/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/04/2024
Section Cited
CCR
102417(g)(8)(A)

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102417 Operation of a Family Child Care Home(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to: 8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841. (A)Health and Safety Code Section 1596.841 states: Each child day care facility shall maintain a current roster of children who are provided care in the facility. The roster shall include the name, address, and daytime telephone number of the child's parent or guardian, and the name and telephone number of the child's physician. This roster shall be available to the licensing agency upon request.

This requirement is not met, as evidenced by:

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Licensee will maintain an updated roster at all times, which will include all children enrolled, including siblings of children in care. Licensee will keep an accurate roster on hand and available for licensing.
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Based on record review, interview and observations, conducted during the course of the complaint investigation, LPAs confirmed facility roster collected on October 11, 2024, was not updated and did not included the names or information of all enrolled children, which poses a potential health, safety, or personal rights risk to children in care.















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Type B
12/04/2024
Section Cited
CCR102425(g)

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102425 INFANT SAFE SLEEP (g)An infant’s head shall not be covered while sleeping.

This requirement is not met, as evidenced by:
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LPAs discussed safe sleep regulations with the licensee. Licensee understands and will no longer give an infant a blanket, while infant is sleeping. Licensee removed blanket from infant's head
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Based on observation and interview, LPAs observed an infant with a blanket on infant's head, which poses a potential health, safety, or personal rights risk to children in care.
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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: 12/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/04/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/04/2024 03:00 PM - It Cannot Be Edited


Created By: Maria Olguin-Leon On 12/04/2024 at 12:15 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: 12/04/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/04/2024
Section Cited
CCR
102425(i)

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102425 INFANT SAFE SLEEP
(i) If an infant falls asleep before being placed in a crib or play yard, the provider shall move the infant to a crib or play yard as soon as possible.

This requirement is not met, as evidenced by:
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Licensee will place sleeping infants in a playpen while infant is sleeping and will ensure playpen is free of blanket or any other articles.
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Based on observation and interview, LPA observed an infant child sleeping on the floor on a mat, which poses a potential health, safety, or personal rights risk to children in care.
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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: 12/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/04/2024


LIC809 (FAS) - (06/04)
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