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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002627
Report Date: 12/06/2024
Date Signed: 12/06/2024 05:08:31 PM

Document Has Been Signed on 12/06/2024 05:08 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:RUSSELL, CARRIE J.FACILITY NUMBER:
414002627
ADMINISTRATOR/
DIRECTOR:		RUSSELL, CARRIE J.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 341-0944
CITY:SAN MATEOSTATE: CAZIP CODE:
94401
CAPACITY: 14TOTAL ENROLLED CHILDREN: 17CENSUS: 4DATE:
12/06/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:40 PM
MET WITH:Carrie J. RussellTIME VISIT/
INSPECTION COMPLETED:
05:15 PM
NARRATIVE
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On December 6, 2024, at approximately 12:35 pm, Licensing Program Analyst (LPA) Zeynep Basak conducted an unannounced annual inspection and met the licensee, Carrie Russell. LPA explained the purpose of the inspection to the licensee.

LPA observed the licensee and 2 helpers were supervising 4 children (1 infant, 1 preschooler, and 2 school age). The licensee stated there are 17 children enrolled the daycare but they have the schedule to alternate their time and make sure they are always operate in capacity. LPA observed the facility complies with the licensing capacity during the time of inspection. LPA reviewed the rotation schedule for enrolled children and found it to be up to date.

LPA verified with the Guardian Roster and found that one of the employee does not have a fingerprint clearance on Guardian website. A Type B violation will be issued on LIC 809D page today. All other adults have criminal clearance and are associated.

The licensee owns two story, four bedroom, 1.5 bathroom home. Licensee stated that there are a total of 4 adults live in the home. Per licensee, the operational hours of Child Care Home are Monday to Friday from 7:00 am to 6:00 pm. According to the licensees, there are no changes to the previously approved childcare areas and off-limit areas.
Daycare Areas: Playroom, Living room, Kitchen, half-bathroom located on first floor, and Front Yard.
Off-Limits Areas: Bedroom 1, Bedroom 2, Bedroom 3, Bedroom 4, Garage, Bathroom located on second floor, upstairs Living Room, upstairs Deck, and Backyard.
See page 2.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Zeynep Basak
LICENSING EVALUATOR SIGNATURE: DATE: 12/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/06/2024
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: RUSSELL, CARRIE J.
FACILITY NUMBER: 414002627
VISIT DATE: 12/06/2024
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Page 2.
Per the licensee, there are no firearms, guns, or weapons in the home. The licensee stated they provide breakfast, lunch, morning and afternoon snacks, in addition to drinking water.

LPA and the licensee inspected the childcare areas for health and safety hazards.LPA observed the home to be clean and in good repair with proper temperature and ventilation. There is a carbon monoxide detectors, and a fully charged fire extinguisher in the size of 2A:10BC in the daycare area. The childcare home has a functioning telephone. LPA verified the contact information.

LPA 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.
LPA observed the two of the off limit areas were not properly locked and barricaded. LPA discussed it with the licensee and the licensee put a gate and a child lock to the areas during the LPA's visit.

LPA observed mats and play yard and individual sheets were observed in the daycare. Also the licensee stated children bring their sheets/blankets from home. LPA observed a loose mattress and sheet in the play yard and Technical Violations will be issued today.

LPA confirmed with the licensee they have an isolation area at the corner of the daycare area for ill children to wait until their parents arrive.

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 6 children's files and verified all required records were in the file, including Immunization records, Emergency cards, and Parental rights forms.
See page 3.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Zeynep Basak
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2024
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: RUSSELL, CARRIE J.
FACILITY NUMBER: 414002627
VISIT DATE: 12/06/2024
NARRATIVE
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Page 3.
The licensee could not provide records of the employees for LPA to review. The licensee stated their files are missing. A Type B violation will be cited on LIC 809D page today. LPA observed one of the staff does not have a Mandated Reporter training and A Type B violation will be cited on the LIC 809D page today.

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

Licensee 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.

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.

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.
See page 4.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Zeynep Basak
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2024
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: RUSSELL, CARRIE J.
FACILITY NUMBER: 414002627
VISIT DATE: 12/06/2024
NARRATIVE
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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.

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.

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.

During the exit interview, the LICENSEE, Carrie J. Russell 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 licensee, Carrie J. Russell.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Zeynep Basak
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/06/2024 05:08 PM - It Cannot Be Edited


Created By: Zeynep Basak On 12/06/2024 at 04:24 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: RUSSELL, CARRIE J.
FACILITY NUMBER: 414002627

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/06/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.871(c)(1)(A)
Administration of Child Day Care Licensing
Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision(f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

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 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/20/2024
Plan of Correction
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The licensee stated she will have her employee to get fingerprint done by the designated date. The licensee stated the employee will be out of the facility until she get her fingerprint clearance completed.
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 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/13/2024
Plan of Correction
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The licensee stated she will provide a proof of the training taken to the LPA via email.
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:Daniel J Oquendo
LICENSING EVALUATOR NAME:Zeynep Basak
LICENSING EVALUATOR SIGNATURE:
DATE: 12/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/06/2024


LIC809 (FAS) - (06/04)
Page: 5 of 8
Document Has Been Signed on 12/06/2024 05:08 PM - It Cannot Be Edited


Created By: Zeynep Basak On 12/06/2024 at 04:24 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: RUSSELL, CARRIE J.
FACILITY NUMBER: 414002627

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/06/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.1(d)
Personnel Records
(d) All personnel records shall be maintained at the child care home and shall be available to the licensing agency for review.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/20/2024
Plan of Correction
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The licensee stated she will have all the personnel records ready for Licensing Staff to review.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Daniel J Oquendo
LICENSING EVALUATOR NAME:Zeynep Basak
LICENSING EVALUATOR SIGNATURE:
DATE: 12/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/06/2024


LIC809 (FAS) - (06/04)
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