414002244-5-3-2023-05-CC-MOLN-CRGV8U-20230503161319

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414002244
Report Date: 05/03/2023
Date Signed: 05/03/2023 04:13:31 PM

Document Has Been Signed on 05/03/2023 04:13 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	LOPEZ, CARMEN L.		FACILITY NUMBER:	414002244
ADMINISTRATOR:	LOPEZ, CARMEN L.		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 688-5729
CITY:	REDWOOD CITY	STATE: CA	ZIP CODE:	94061
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 10	CENSUS: 9	DATE:	05/03/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:52 PM
MET WITH:	Carmen Lopez		TIME COMPLETED:	04:35 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 May 5, 2023, Licensing Program Analyst (LPA) Maria Olguin-Leon met with Licensee, Carmen Lopez for an unannounced annual inspection. The purpose of the inspection was explained. Present today is Licensee, two assistants, and 9 children ( 6 infants & 3 toddler). At 2:20 pm 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 All adults living in home have criminal record clearances on file with the department. Hours of operation are Monday– Friday, 8:00am to 5:30pm. LPA and Licensee toured the home for health and safety hazards. The home is owned by Licensee and is a one-story home. Day Care Areas: Playroom #1 and Playroom #2 and Living room (for napping purpose only) & Bathroom #1 and front yard. Off Limits Areas: All three bedroom, kitchen, dining room and bathroom #2. backyard and garage. Fireplace in living room is properly barricaded. The home is clean and has proper ventilation. Cleaning supplies and other potentially harmful items are stored inaccessible to the children. There are plenty of age-appropriate toys, child size furnishings, learning material and cribs. Licensee provides children’s bedding and washes them weekly. Front play yard is completely fenced and has plenty of toys and play equipment in good repair. There are no pools, spas, or other bodies of water on the property. Licensee provides and cooks meals for children in care. LPA observed food to be properly stored to avoid contamination. The home is equipped with a carbon monoxide detector, smoke detector and a fully charged fire extinguisher located in kitchen. Isolation area for ill children is in living room away from other children. First aid kit is fully stocked with supplies. Home is equipped with cell phone and license understands phone is to be kept at facility during daycare hours. Per licensee there are no weapons or firearms in the home. LPA reviewed 5 children’s records and all required documents were in children’s files. Children’s files have completed LIC282. All staff CPR/First Aid expires 10/2025, Mandated Reporter will be completed and email to LPA, technical citation cited. Licensee will update staff files for completion, technical citation cited. Children’s roster was reviewed and is up to date. Last emergency drill was documented on 01/09/2023. Cont. page 2...

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023

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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: LOPEZ, CARMEN L.	FACILITY NUMBER: 414002244
	VISIT DATE: 05/03/2023

NARRATIVE

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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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. Where 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 and Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

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. LPA reviewed AB 1207 with the Licensee. 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.

LPA encouraged the Licensee to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. The Licensee can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

Safe Sleep

LPA discussed the safe sleep regulations with licensee Carmen Lopez 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 resources.

Cont. page 3...

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023

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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: LOPEZ, CARMEN L.	FACILITY NUMBER: 414002244
	VISIT DATE: 05/03/2023

NARRATIVE

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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.

LPA reviewed AB 1207 with the Licensee. 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.

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.

**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.

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, Carmen Lopez.
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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 05/03/2023 04:13 PM - It Cannot Be Edited

Created By: Maria Olguin-Leon On 05/03/2023 at 03:41 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: LOPEZ, CARMEN L.	FACILITY NUMBER: 414002244
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/03/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

102416.5(d)(1)

Staffing Ratio and Capacity

(d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either: (1) Twelve children, no more than four of whom may be infants; or This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, and record review, the licensee did not comply with the section cited above in 6 children out of 9, are under the age of 2, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 05/04/2023
	Plan of Correction
1 2 3 4	Licensee will reduce care for two children to part time. Each child coming on opposite days to reduce capacity to 4 infants per day.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Ali Zebila

LICENSING EVALUATOR NAME:

Maria Olguin-Leon

LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023

LIC809 (FAS) - (06/04)

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