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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002137
Report Date: 07/16/2024
Date Signed: 07/16/2024 04:18:44 PM

Document Has Been Signed on 07/16/2024 04:18 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:TEJADA, GRACIELA Y. & TEJADA, MIGUEL A.FACILITY NUMBER:
414002137
ADMINISTRATOR/
DIRECTOR:		TEJADA, GRACIELA Y.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 401-3821
CITY:SAN MATEOSTATE: CAZIP CODE:
94401
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 10DATE:
07/16/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:40 PM
MET WITH:Graciela Tejada & Miguel TejadaTIME VISIT/
INSPECTION COMPLETED:
04:20 PM
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On July 16, 2024 at approximately 2:40pm, Licensing Program Analysts (LPAs) Basak and Quimbo conducted an unannounced, case management visit. LPAs met with licensee, Graciela Tejada, and explained the purpose of the visit. Present during visit included, co-licensee, Miguel Tejada, licensees' assistant/adult child (A1), and 10 children (3 infants and 7 preschool age).

Co-licensees requested to add off limit areas (kitchen, living room, bathroom #2, bedroom #2) as a day care area. Fire clearance for off limit areas has been received July 3, 2024. LPAs inspected the day care areas to be added for health and safety hazards.

The DAY CARE AREAS now approved are playroom #1, playroom #2, bathroom #3, backyard, bedroom #2 (converted to infant room), and bathroom #2 (located in infant room). The OFF LIMIT AREAS are the bedroom #1, bedroom #3, bathroom #1, storage units in the backyard and garage. LPA advised licensee to install child safety door handles on off limit doors.

LPAs observed day care areas to be added to be clean. LPAs observed poisons and cleaning solutions to be stored behind child safety locked cabinets. LPAs observed knives and sharp objects to be made inaccessible to children. Infant room includes a variety of toys and equipment that are in good condition. Bathroom #2 was observed to be in working condition. There is a dual smoke/carbon monoxide detector in the kitchen, that was observed to be working. LPAs observed electrical outlets to be made inaccessible with child safety covers. Furniture and equipment in day care areas to be added are in good condition.

LPAs will approve for infant room, bathroom #2 and kitchen as day care areas. LPAs will approve for the living room as a day care area when the fireplace is made inaccessible. Proof of inaccessibility will be provided to LPA Basak.

No deficiencies were issued during today's visit. Notice of site visit given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with licensee, Graciela Tejada.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE: DATE: 07/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/16/2024
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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