414002373-8-1-2024-05-CC-ZBAK-D7QVYA-20240801165050

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414002373
Report Date: 08/01/2024
Date Signed: 08/01/2024 04:50:58 PM

Document Has Been Signed on 08/01/2024 04:50 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:	CHAVEZ-CRUZ, DELMA & MEDINA, MARCELA		FACILITY NUMBER:	414002373
ADMINISTRATOR/ DIRECTOR:	D. CHAVEZ-CRUZ & M. MEDINA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 685-6645
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94401
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 10	CENSUS: 10	DATE:	08/01/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:25 PM
MET WITH:	Delma Chavez Cruz and Marcela Medina Chavez		TIME VISIT/ INSPECTION COMPLETED:	05:10 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 1, 2024 at approximately 1:25pm, Licensing Program Analysts (LPAs) Basak and Tapia-Mandujano conducted an unannounced annual inspection and met the Licensees, Marcela Medina, and Delma Chavez-Cruz. LPAs explained the purpose of the inspection to the Licensees. LPAs observed the licensees and the helper supervising 9 children (1 infant, 7 preschoolers, and 1 school-age). The licensee complies with the licensing capacity during 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. Licensee's own 3 bedroom home. Licensees stated that there are a total of 5 adults and minor child that lives in the home. Per licensees, the operational hours of Child Care Home are Monday to Friday from 7:00 am to 5:30 pm. Day Care Areas: Living room, dining area, kitchen (pass through only), bathroom, backyard, and backyard bathroom. Off Limit Areas: Bedroom #1, bedroom #2, bedroom #3, garage, and storage unit in backyard. LPAs observed the home to be clean and in good repair with proper temperature and ventilation. There are two 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. LPAs verified contact information. Per the Licensees, there are no firearms, guns, or weapons in the home. The Licensees stated they provide breakfast, lunch, morning and afternoon snacks, in addition to drinking water. See page 2.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Zeynep Basak
LICENSING EVALUATOR SIGNATURE:	DATE: 08/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2024

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: CHAVEZ-CRUZ, DELMA & MEDINA, MARCELA	FACILITY NUMBER: 414002373
	VISIT DATE: 08/01/2024

NARRATIVE

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LPAs and the Licensee inspected the childcare areas for health and safety hazards. The childcare area is clean and free from hazards. LPAs observed all cleaning supplies, and other chemicals are stored properly and inaccessible to children. LPAs 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. LPAs confirmed with the licensee they have an isolation area in the dining room for ill children to wait until their parents arrive.

During today's inspection, facility currently does not have any infant children who sleep in cribs or play yards. Licensee was informed about the sleep log, to check infant children every 15 minutes during naptime. The Licensee understood and acknowledges that no baby walkers, bouncers, or other similar items are permissible to be used during daycare hours.

LPAs reviewed the staff file and found Licensees have a valid CPR & First Aid. LPAs found the licensees, and the helper’s Mandated Reporter Training has expired, and Technical Violation was issued. Per the Licensee, the emergency drills are conducted at least once every six months, and the latest drill was conducted on July 21, 2024.

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

LPAs observed all mandatory postings are posted in Child Care Home including License, Parent's Rights poster, and Floor map.

See page 3.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Zeynep Basak
LICENSING EVALUATOR SIGNATURE:	DATE: 08/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2024

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: CHAVEZ-CRUZ, DELMA & MEDINA, MARCELA	FACILITY NUMBER: 414002373
	VISIT DATE: 08/01/2024

NARRATIVE

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Licensees were 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.

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.

LPAs 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 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: 08/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2024

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: CHAVEZ-CRUZ, DELMA & MEDINA, MARCELA	FACILITY NUMBER: 414002373
	VISIT DATE: 08/01/2024

NARRATIVE

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LPAs 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, Marcela Medina, and Delma Chavez-Cruz confirmed that there are no Registered Sex Offenders living in the facility, and LPAs 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, Marcela Medina and Delma Chavez-Cruz.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Zeynep Basak
LICENSING EVALUATOR SIGNATURE:	DATE: 08/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2024

LIC809 (FAS) - (06/04)

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