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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002885
Report Date: 01/26/2023
Date Signed: 01/26/2023 10:37:32 AM

Document Has Been Signed on 01/26/2023 10:37 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PENINSULA CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:SANTIAGO, ANA BERTHAFACILITY NUMBER:
414002885
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
01/26/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Ana Bertha SantiagoTIME COMPLETED:
10:40 AM
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On 1/26/2023 at 8:45AM., Licensing Program Analyst (LPA), Luis J. Gomez met with Licensee, Ana Bertha Santiago. The purpose of the inspection was explained and was unannounced; Case Management for Increase of Capacity. Present was the licensee caring for four children (Two Preschool Age and Two Infant Age) All adults have criminal record clearances on file. During inspection, Fire Marshal from Cal Fire Department arrived to the facility. Day-care Areas are: Bedroom #2 (Back), Bedroom #1 (Front), Bathroom #2 (Front) Bathroom #2 (Back), Living Room (Playroom), Dining Area/Kitchen and Outdoor Play Area. Off-limit Areas are: Bedroom #3 and Front Patio. LPA inspected home, indoors and outdoors, with licensee for health and safety hazards.

At 8:55AM., LPA observed the following: Facility was clean, orderly with age-appropriate playthings available for the children. Furniture, books and items inspected were in good repair. Child size tables and chairs available for snack and seated activities. For napping services, facility is equipped with mats, playpens and cribs with tight-fitting sheet stored in the bedroom #1, #2. Bathroom #1, #2 had adequate supplies for hand-washing. Fixtures tested were in proper working order. Detergents, cleaning supplies are stored in off-limit area. All outlets and trash bins have been properly covered. Home has functioning telephone, smoke detector, carbon monoxide detector and fully charged fire extinguisher (3A:40:BC) located in the hallway.

LPA inspected the outdoor play area. The outdoor spaces was completely enclosed. Outside playthings were in good repair. Storage shed was reviewed during inspection. Home does not have any pools, fishponds, bodies of water on the premises.

Licensee’s required mandated reporter training certification (AB1207) was current expiring: 1/29/2024.


Licensee’s Cardiopulmonary Resuscitation (CPR)/ First Aid Certification was current, expiring: 6/11/2023.
(REFER TO 809C, FOR CONT.)
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/26/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PENINSULA CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: SANTIAGO, ANA BERTHA
FACILITY NUMBER: 414002885
VISIT DATE: 01/26/2023
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Licensee was reminded 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 for influenza, pertussis and measles or qualifies for an exemption pursuant to Health and Safety Code 1596.7995 and 1597.662.

Licensee was reminded that 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.

LPA reviewed 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.

During today's inspection licensee submitted: STD850, Fire Safety Inspection Request Approval.

On 1/26/2023, Licensee will be recommended for approval of Large Capacity Licensure.

Exit interview was conducted with Licensee, Ana Bertha Santiago and copy of this report was provided. This report will be kept in the facility file and made available for public review upon request. Desk Duty is available Monday through Friday between 8AM - 5PM at (650) 266 -8800.

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023
LIC809 (FAS) - (06/04)
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