414002614-4-11-2023-05-CC-LGOZ-CQSVNC-20230411163455

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414002614
Report Date: 04/11/2023
Date Signed: 04/11/2023 04:35:09 PM

Document Has Been Signed on 04/11/2023 04:35 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:	PITA, VICTORIA		FACILITY NUMBER:	414002614
ADMINISTRATOR:	PITA, VICTORIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 483-8985
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94402
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 4	DATE:	04/11/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Victoria Pita		TIME COMPLETED:	04:45 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 4/11/2023 at 2:30PM., Licensing Program Analysts (LPA), Luis J. Gomez met with Licensee, Victoria Pita. Purpose of the inspection was explained and was for an Unannounced; Annual Random inspection. Present in facility was the licensee caring for four children. Child present were preschool-age. Adults have criminal record clearances on file. Licensee’s home is a five bedroom, two bathroom, one level house. Days and Hours of operations are: Monday – Friday, 7:00AM., to 5:15PM. Day-care Areas: Living Room #2 (Playroom), Bathroom #1, and Backyard Area. Off-limit Area: Bedrooms #1, #2, #3, #4, #5, Kitchen, Bathroom #2, Living Room, and Garage. LPA inspected facility with licensee, for health and safety hazards. At 2:35PM., the following was observed: Facility was clean, orderly, with age-appropriate playthings available for the children. Floors and ground surfaces were clear of obstructions or hazards. Accessible furniture, toys and books inspected were in good repair. Child sized table and chairs are available in playroom for snack and seated activities. For napping services, LPA observed mats stored in facility. Per licensee, napping sheets are washed weekly by families. Off-limit area have been made inaccessible. Bathroom #1 was maintained clean, with stepping stool and adequate supplies for hand washing. Fixture were in operating condition. Facility was the proper temperature, with ventilation, and lighting. Home had functioning telephone service, smoke detector, and carbon monoxide detector. At 2:45PM., Based on observation, LPA confirmed fire extinguisher in playroom not the proper size. Advisory Note: Technical Violation (LIC9102TV) was issued. At 2:50PM., LPA inspected backyard area. Area is completely enclosed with tall fencing and was free of debris or hazardous plants. Structure had been anchored, and sandbox was properly covered. Home does not have any pools, fishponds, jacuzzi, or bodies of water. LPA reminded licensee to remove broken/ damaged playthings from back yard area. Advisory Note: Technical Violation (LIC9102TV) was used. (REFER TO 809C, FOR CONT)

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2023

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: PITA, VICTORIA	FACILITY NUMBER: 414002614
	VISIT DATE: 04/11/2023

NARRATIVE

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At 3:05PM, LPA reviewed facility and children’s records. Children’s files were reviewed and included the: Identification of Emergency Information (LIC700); Notification of Parent's Rights (LIC995); and Consent for Medical Treatment (LIC627).

LPA reminded licensee to ensure children immunization records are stored facility. Advisory Note: Technical Assistance (LIC9102TV) was issued.

Licensee’s Cardiopulmonary Resuscitation (CPR)/ First Aid certification was current, expiring: 3/31/2025.

Licensee’s required 'Mandated Reporter Training' certification (AB1207) was current, expiring: 7/7/2023.

Licensee’s is conduct, and document emergency disaster drills once every 6 months, with last drill done on: 2/1/2023, properly logged.

Required posting are posted, including Childcare License, Notification of Parent’s Rights (PUB379), Emergency Disaster Plan (LIC610A). Per licensee, isolation of an ill children is in the playroom.

LPA advised licensee to ensure all children’s meal containers brought by families must be labeled. Per licensee, home does not have any firearms.

Licensee was reminded all adults, 18 years and over, living or working in the home, including employee and volunteers, must obtain criminal 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.

(REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2023

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: PITA, VICTORIA	FACILITY NUMBER: 414002614
	VISIT DATE: 04/11/2023

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LPA discussed the safe sleep regulations with licensee and discussed Child Care Licensing Safe Sleep Web page at:https://www.cdss.ca.gov/inforesource/child-care-licesning/public-information-and-resources/safe-sleep as an additional resource. LPA informed licensee of the importance of checking for recalled infant devices on United States consumer Product Safety Commission (CPSC) website at http://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 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 tool, please send them 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/inforesource/community-care-licensing/inspection-process.

Based on today's inspection, no deficiencies were observed in areas evaluated according to California Title 22, Div. 12 Chap. 3 Health and Safety Code of Regulations. In exit interview, evaluation report was discussed with Licensee, Victoria Pita, and signature of this form acknowledges receipt of these documents.

Notice of Site Visit was provided and must remain posted for 30 days.

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2023

LIC809 (FAS) - (06/04)

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