<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002137
Report Date: 08/13/2024
Date Signed: 08/13/2024 03:59:46 PM

Document Has Been Signed on 08/13/2024 03:59 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: 11DATE:
08/13/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:50 PM
MET WITH:Graciela & Miguel TejadaTIME VISIT/
INSPECTION COMPLETED:
04:15 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 13, 2024, at approximately 1:45 pm, Licensing Program Analyst (LPA) Basak conducted an unannounced annual inspection and met the Licensees, Graciela and Miguel Tejada. LPA explained the purpose of the inspection to the Licensees.

LPA observed the licensees and the helper supervising 11 children (3 infant, 8 preschoolers). The licensee complies with the licensing capacity during the time of inspection. The children's roster has been reviewed and found to be complete and up to date.

LPA verified with the Guardian Roster that all present adults have criminal clearance and are associated. According to the licensees, there are no changes to the previously approved childcare areas and off-limit areas.

Licensees stated that there are a total 2 adults lives in the home. Per licensees, the operational hours of Child Care Home are Monday to Friday from 8:00 am to 5:30 pm. Day Care Areas: Living room, master bedroom, kitchen, kids room #1, kids room #2, bathroom # 2 and 3, and backyard. Off Limit Areas: bedroom #2, bedroom #3, master bathroom, bathroom #2, garage, and unit located at the back of the backyard.
LPA observed the home to be clean and in good repair with proper temperature and ventilation. There are multiple working smoke detectors, carbon monoxide detectors, and a fully charged fire extinguisher in the size of 2A:10BC in the kitchen area. The childcare home has a functioning telephone. Per the Licensees, there are no firearms, guns, or weapons in the home. The Licensees stated they provide breakfast, lunch, dinner and snack, in addition to drinking water.

See page 2.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Zeynep Basak
LICENSING EVALUATOR SIGNATURE: DATE: 08/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/13/2024
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 4
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: TEJADA, GRACIELA Y. & TEJADA, MIGUEL A.
FACILITY NUMBER: 414002137
VISIT DATE: 08/13/2024
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
26
27
28
29
30
31
32
Page 2
LPA and the Licensee inspected the childcare areas for health and safety hazards. The childcare area is clean and free from hazards. LPA observed all cleaning supplies, and other chemicals are stored properly and inaccessible to children. LPA observed a daycare area is equipped with age-appropriate furniture, toys, books, and educational materials.

Mats and individual sheets were observed in the napping area and the licensee verified children bring their sheets/blankets from home. LPA confirmed with the licensee they have an isolation area in the backyard for ill children to wait until their parents arrive.

During today's inspection, facility currently have 3 infant who sleep in cribs. LPA observed there is no blanket or other items in the crib or hanging over. Licensee was informed about the sleep log, to check infant children every 15 minutes during naptime. The Licensee understood and acknowledged that no baby walkers, bouncers, or other similar items are permissible to be used during daycare hours.

LPA reviewed the staff file and found Licensees and helper have valid CPR & First Aid, and Mandated Reporter Training. Per the Licensee, the emergency drills are conducted, and the latest drill was conducted on January 12, 2024. LPA reminded to licensees emergency drill to be conducted at least once every six month.

LPA reviewed the 3 infant and 3 preschool children's files and verified all required records were in the file, including Immunization records, Emergency cards, and Parental rights forms.

LPA observed all mandatory postings are posted in Child Care Home including Licenses, Parent's Rights posters, and Floor maps.

See page 3.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Zeynep Basak
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: TEJADA, GRACIELA Y. & TEJADA, MIGUEL A.
FACILITY NUMBER: 414002137
VISIT DATE: 08/13/2024
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
26
27
28
29
30
31
32
Page 3
Licensees were reminded about the Provider Information Notices (PINs) on the CCLD website. The 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.

The licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with the licensee and discussed the Child Care Licensing Safe Sleep webpage https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed the 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. Per licensees there was no child present has an allergy at the facility. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: www.ada.gov/childqanda.htm.
See page 4.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Zeynep Basak
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: TEJADA, GRACIELA Y. & TEJADA, MIGUEL A.
FACILITY NUMBER: 414002137
VISIT DATE: 08/13/2024
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
26
27
28
29
30
31
32
Page 4
LPA reviewed AB 1207 with the Licensees. As of January 1, 2018, all staff must complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families find childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

During the exit interview, the LICENSEEs, Graciela and Miguel Tejada confirmed that there are no Registered Sex Offenders living in the facility, and LPA completed the RSO profile in FAS.

A notice of site visit was given and must remain posted for 30 days.

An exit interview was conducted, and the report was reviewed with the licensees, Graciela and Miguel Tejada.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Zeynep Basak
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2024
LIC809 (FAS) - (06/04)
Page: 4 of 4