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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004279
Report Date: 12/19/2024
Date Signed: 12/19/2024 12:19:37 PM

Document Has Been Signed on 12/19/2024 12:19 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:ROCHA, BARBARA M.FACILITY NUMBER:
414004279
ADMINISTRATOR/
DIRECTOR:		ROCHA, BARBARA M.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 712-9799
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94063
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 8DATE:
12/19/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Licensee, Barbara M. RochaTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
NARRATIVE
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On December 19th, 2024, at approximately 9am, Licensing Program Analyst (LPA) Tapia-Mandujano conducted an unannounced random/annual inspection and met with licensee, Barbara M. Rocha. LPA explained the purpose of the inspection licensee. Present in the facility is licensee and assistant supervising 8 children (4 infants and 4 preschool age children). During time of the inspection, licensee is operating within capacity limits. All adults living and working in the facility are fingerprint cleared and associated.

Licensee rents home, which is a two unit home. Front Unit ‘B’ has 2 rooms and 1 Bathroom. Unit ‘A’ in the back has two levels and has 4 bedrooms and 2 bathrooms. Units are connected by the Laundry room. Property has a two car detached garage. Licensee lives with Husband and 2 minor children. The hours of operation are Monday-Friday 7:30-5pm. Daycare areas are: Front Unit 'B': Living room, Room #1, Room #2 with Bathroom #1, Front yard, and portion of Side yard/Driveway. OFF limit area: Unit 'B': Kitchen, Laundry area, portion of side yard/driveway, and backyard; and Entire Unit 'A'. Side yard/Driveway is divided by a ‘retractable’ gate. All off limit areas, including closets, are properly barricaded.

LPA observed the Day-care is clean, orderly with a variety of age-appropriate toys for the children. All furniture inspected is in good repair. The applicant has a fully stocked First Aid kit and was reminded to be aware of the expiration on the First Aid Kit. The home has no pools or bodies of water in the home. LPA reminded licensee about water safety. The home has a fireplace in an off limit area. Per licensee there is pets in the back of the home. The home has age-appropriate equipment available for children in care. Licensee was reminded that baby walkers, bouncers, jumpers and any other similar items are to not be used for children in care. Licensee has uses pack and play for infant children to sleep. Infant children are sleeping in the bedrooms.

There was a fully charged fire extinguisher and carbon monoxide alarm, and a working telephone. Phone number listed for Licensee is current. Per Licensee, there are no weapons or firearms in the home. LPA reviewed eight children’s records. Licensee's Mandated reporter training will expire on 03/2025. Licensee's Pediatric CPR/First Aid Certification Expires 02/2025. Last Emergency drill was conducted 12/2024. Emergency drills must be conducted at least once every six months and must be properly logged.

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SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE: DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/19/2024
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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Document Has Been Signed on 12/19/2024 12:19 PM - It Cannot Be Edited


Created By: Leslit Tapia-Mandujano On 12/19/2024 at 11:27 AM
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: ROCHA, BARBARA M.
FACILITY NUMBER: 414004279

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/19/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above as the sleep logs are not being properly done and/or maintained which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/17/2025
Plan of Correction
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Licensee was explained the requirements for Sleep logs. LPA provided PIN 20-24-CCP for Safe Sleep Regulations.

LPA will do the sleep logs for all infant children enrolled starting today until 1/17/25 and submit proof of documenting the sleep logs to LPA Tapia-Mandujano via email.
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:Marie Rodriguez
LICENSING EVALUATOR NAME:Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE:
DATE: 12/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/19/2024


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: ROCHA, BARBARA M.
FACILITY NUMBER: 414004279
VISIT DATE: 12/19/2024
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All the required posting documentation, such as the facility license, Notification of Parental Rights and have been placed in a prominent area for parents or representatives to review. Discipline Policy was also discussed.

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 atwww.cdss.ca.gov/inforesources/community-care-licensing/inspection-process

Licensee was reminded that all adults 18 and over, 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 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.

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. LPA also informed 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. Licensee does not offer IMS at this moment. 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/.

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SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024
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: ROCHA, BARBARA M.
FACILITY NUMBER: 414004279
VISIT DATE: 12/19/2024
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Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the licensee, Barbara M. Rocha, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS on 12/19/24.

Deficiencies were cited 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, Barbara M. Rocha.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024
LIC809 (FAS) - (06/04)
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