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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002244
Report Date: 06/13/2024
Date Signed: 06/13/2024 01:15:16 PM

Document Has Been Signed on 06/13/2024 01:15 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:LOPEZ, CARMEN L.FACILITY NUMBER:
414002244
ADMINISTRATOR/
DIRECTOR:		LOPEZ, CARMEN L.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 688-5729
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94061
CAPACITY: 14TOTAL ENROLLED CHILDREN: 9CENSUS: 9DATE:
06/13/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:01 AM
MET WITH:Carmen CazaresTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
NARRATIVE
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On June 13, 2024, at approximately 9:00pm, Licensing Program Analyst (LPA) Maria Olguin-Leon conducted an unannounced annual inspection and met with licensee Carmen Cazares, and purpose of inspection was explained. Present during today’s visit was Licensee, licensee’s son, two helpers and 9 children (2 infant and 7 preschool age). Licensee is operating within capacity and ratio requirements on this day. All adults present today have criminal background clearance. Facility hours of operation are Monday - Friday from 8:00AM to 5:00PM.

LPA and Licensee toured the home for health and safety hazards. Home is a single level story home. Day Care Areas: Playroom #1 (infant area) and playroom #2 (preschool area), living room (isolation only for sick children), bathroom #2 and play park. Children enter home through main entrance and walk through hallway and dining room into daycare areas. Off Limits Areas: Kitchen, living room, all three bedrooms, bathroom #1 and back yard area. LPA observed home to be clean and orderly. Home is well light and has proper ventilation. LPA observed electrical outlets are secured with child proof covers. Cleaning supplies and other potentially harmful items are stored inaccessible to children. Fireplace located in living room is properly barricaded with a fireplace screen. There are plenty of age-appropriate toys, books, child size furnishings, learning material, cubbies and sleeping mats, cribs and two changing table. Play yard has a swing set, small climbing dome, tables, ride-on toys, and age-appropriate toys all in good repair. Outdoor is equipped with cement patio and artificial grass is underneath swing set to cushion falls. The entire backyard is surrounded with a 5 ft. fence. LPA did not observe any spas, pools, or other bodies of water.

Home is equipped with a working dual carbon monoxide/smoke detector and a fully charged fire extinguisher. Isolation area for ill children will be in living room and away from other children. LPA reviewed first aid kit and kit is fully stocked. Licensee uses a cell on the premises and is aware to keep phone at the facility during daycare hours. Per licensee, there are no weapons or firearms in the home. Licensee provides sheets and blankets for children in care and washes them on a weekly basis or as needed.

Cont. page 2…
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE: DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/13/2024
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: LOPEZ, CARMEN L.
FACILITY NUMBER: 414002244
VISIT DATE: 06/13/2024
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LPA reviewed 5 children’s files and 2 staff records. All children’s files were complete with all required documents, including LIC282 and LIC9150. Licensee maintains an updated Children’s roster and sleep logs. Licensee will email copy of CPR/FA certificate to LPA. Licensee Mandated Reporter training expires 05/2025. Staff is missing mandated reporter. Licensee provides meals to children in care, which included breakfast, lunch, and snacks. LPA observed Childcare License, Emergency Disaster Plan (LIC610A) and Parent's rights posted. LPA reminded licensee of the importance of conducting emergency drills every 6 months and to properly document.

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.

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/.

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's reviewed AB 1207 with the Licensee.

As of January 1, 2018, all staff must complete Mandated Reporter Training every two years. LPA reminded licensee about Mandated Reporter training available www.mandatedreporterca.com


Cont. page 3...
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024
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: LOPEZ, CARMEN L.
FACILITY NUMBER: 414002244
VISIT DATE: 06/13/2024
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LPA discussed the safe sleep regulations with Licensee 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 resource. LPAs also informed licensees 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.

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

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

During the exit interview, the LICENSEE, Carmen Lopez confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.



**See 809D page for deficiencies cited against the facility today under CCR, Title 22, Div. 12, Chapt. 1**

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

Exit interview conducted and report was reviewed with the licensee, Carmen Cazares. LPA translated report in Spanihs to licensee.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/13/2024 01:15 PM - It Cannot Be Edited


Created By: Maria Olguin-Leon On 06/13/2024 at 12:42 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: 06/13/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above in 3 out of 3 staff do not have CPR/First Aid certification, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/27/2024
Plan of Correction
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Licensee is in process of signing up for CPR/First Aid training will be submit certification to LPA by POC date.
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above in 2 out of 2 employees have not completed mandated reporting training, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/27/2024
Plan of Correction
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Staff will complete mandated reporter training by POC date and will submit certificate to LPA.
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: 06/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/13/2024


LIC809 (FAS) - (06/04)
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