414002060-6-18-2024-05-CC-MZAA-D6CQUL-20240618122855

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414002060
Report Date: 06/18/2024
Date Signed: 06/18/2024 12:29:00 PM

Document Has Been Signed on 06/18/2024 12:29 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:	MADLAMBAYAN, LUCIA CECILIA		FACILITY NUMBER:	414002060
ADMINISTRATOR:	MADLAMBAYAN, LUCIA C.		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 873-5837
CITY:	SAN BRUNO	STATE: CA	ZIP CODE:	94066
CAPACITY:	14	CENSUS: 2	DATE:	06/18/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Licensee, Lucia Cecilia Madlambayan		TIME COMPLETED:	12:50 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 June 6, 2024 at approximately 10:30am, Licensing Program Analyst (LPA) Melissa Zaragoza conducted an unannounced, annual inspection. LPA was greeted and granted access by licensee, Lucia Cecilia Madlambayan. At the entrance licensee was explained the purpose of the inspection. Present during LPA's visit included Licensee, and 2 children (2 preschool age). Hours of operation are Monday through Friday 7:30am to 6:00pm. Licensee lives in a one-level home with their spouse. All adults living in the home and licensee, have fingerprint clearance on file. The DAY CARE AREAS are the living room, dining room, kitchen, playroom, backyard, and bathroom #1. The OFF LIMIT AREAS are garage, bedroom #1, bedroom #2, bedroom #3, and bathroom #2. LPA toured day care areas of home with licensee. LPA observed home to be in good repair with proper temperature and ventilation. Home is equipped with a variety of toys and materials that were observed to be in good condition. LPA observed books, school supplies, and many more curriculum material that help children’s learning. Cleaning supplies, poisons and hazardous materials are stored in home's high shelves and/or locked behind child safety locked cabinets. Home is equipped with a fully charged fire extinguisher and a dual smoke and carbon monoxide detector. Smoke and carbon monoxide detector were tested during visit and was observed to be in working condition. There are no pools, and bodies of water in the premises. Napping room (playroom) was observed to be equipped with cots for napping children. LPA observed cots to have tight fitting sheets. Per licensee, children bring blankets and sheets from home, and are take home every Friday for cleaning. Per licensee, they are present when children are napping. (Continue Report on Page 2...)

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8827
LICENSING EVALUATOR NAME: Melissa Zaragoza	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024

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: MADLAMBAYAN, LUCIA CECILIA	FACILITY NUMBER: 414002060
	VISIT DATE: 06/18/2024

NARRATIVE

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Bathroom was observed to be in proper working condition. There is appropriate sanitation and toileting equipment for children in care. LPA observed children’s diapers and wipes in playroom to be properly stored. Per licensee, children’s families provide diapers and wipes for enrolled child.

Children eat in kitchen area. A food service is provided to children that includes snack only. LPA observed eating area to be clean and equipped with appropriate dining furniture. Per licensee, children bring lunch from home in their own individual lunch box. Per licensee, there are no children with dietary restrictions or allergies.

Outdoor area is entirely enclosed and fenced. Outdoor area includes a variety of toys and equipment that were in good condition. Backyard area has a natural shade from trees in back yard. Backyard has cushion flooring at the bottom of the at home portable play sets. LPA did not observe any pools, spas or bodies of water on site.

LPA reviewed 2 children's records which were complete. LPA reviewed licensee’s records which were complete. Licensee has a current CPR/First Aid certifications and current Mandated Reporter certifications. Licensee's CPR/First Aid certification will expire 04/16/2025 and Mandated Reporter certifications will expire 08/2025.

Emergency disaster drills are conducted and are appropriately documented. Last disaster drill was conducted 04/2024. LPA observed licensing documentation to be properly posted, made available for review. Facility maintains a childcare roster that was also made available for review. Per licensee, there are weapons or firearms in the home. LPA observed weapons to be stored in safe, in an off limit area, made inaccessible 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.

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SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8827
LICENSING EVALUATOR NAME: Melissa Zaragoza	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: MADLAMBAYAN, LUCIA CECILIA	FACILITY NUMBER: 414002060
	VISIT DATE: 06/18/2024

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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.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://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 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, Lucia Cecilia Madlambayan, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed a Megan’s Law search on 06/03/2024.

No deficiencies were issued 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, Lucia Cecilia Madlambayan .

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8827
LICENSING EVALUATOR NAME: Melissa Zaragoza	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024

LIC809 (FAS) - (06/04)

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