<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004296
Report Date: 03/19/2024
Date Signed: 03/19/2024 02:21:12 PM

Document Has Been Signed on 03/19/2024 02:21 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:CASTRO, TERESAFACILITY NUMBER:
414004296
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
03/19/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Byanka Ramos, Teresa CastroTIME COMPLETED:
02:30 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 3/19/2024 at 11:00AM., Licensing Program Analyst (LPA), Luis Gomez met with Licensee, Teresa Castro and Licensee's Daughter/ Assistant Byanka Castro. The purpose of the visit was explained and was for an Unannounced/ Random Inspection and Case Management for Increase of Capacity. Licensee is also requesting to add bedroom #2, to the on-limit areas. Present was the licensee and licensee’s daughter, caring for 3 children (2 Infant-age, 1 Preschool- age). The adults present have criminal record clearances on file. Licensee’s home is a 2 bedroom, 1 bathroom, 1 level unit. Per licensee, the days and hours of operations are: Monday- Friday 8:00 AM.- 5:00 PM. The areas of the home designated for childcare are: Living room (Play Area); Kitchen; Bathroom #1; and Backyard Area. The areas of the home designated as off- limit are: Bedroom #1 and Bedroom #2. LPA inspected home for health and safety hazards.

At 11:10AM., the following was observed: Facility was clean and orderly with age-appropriate playthings available for the children. Floor and ground surfaces were clear of any obstructions or hazards. Accessible furniture, toys, and books were in good repair. For food services, facility has wide- based feeding chairs located in the kitchen. LPA observed several tables and chairs, scaled to the size of the children. The low-hanging cabinets in the kitchen have safety locks installed. For scheduled nap, LPA observed infant play pens and mattresses stored in facility. The play pens were equipped with a properly sized mattress, and tightly fitted bedsheets. Per licensee’s daughter, children’s napping linens are washed weekly. Bathroom #1 was maintained clean with fixtures in operating condition. Facility was the proper temperature with ventilation and adequate lighting. The off-limit areas of the home have been made inaccessible. Facility detergents, cleaning compound, toxins and items (which pose a danger) have been stored inaccessible to children. Licensee’s home had functioning telephone service; carbon monoxide/ smoke detector combination detector; and fire extinguisher: 2A:10:BC. First aid kit was reviewed during inspection.

At 11:35AM., LPA inspected the backyard area. Area was completely enclosed with shading, and an accessible grass area. The outside playthings were in like-new condition.

LPA reminded licensee to ensure all sharp corners in backyard area are removed and/or covered. Facility was issued, Advisory Note: Technical Violation (LIC9102TV).

Facility does not have any pools, fishponds, jacuzzi or bodies of water.


(REFER TO 809c, FOR CONT)
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 03/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/19/2024
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 6
Document Has Been Signed on 03/19/2024 02:21 PM - It Cannot Be Edited


Created By: Luis Gomez On 03/19/2024 at 12:20 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: CASTRO, TERESA
FACILITY NUMBER: 414004296

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/19/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)(D)(c)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
At 12:10PM., Based on record review and interview, LPA confirmed licensee is not documenting infant napping conditions during each 15-minute review. This poses a potential health and safety risk to children in care.
POC Due Date: 03/21/2024
Plan of Correction
1
2
3
4
Licensee will begin documenting infant napping condition every 15 minutes, by the due date: 3/21/2024.

Proof of correction will be submitted to the Department via email.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:Luis Gomez
LICENSING EVALUATOR SIGNATURE:
DATE: 03/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/19/2024


LIC809 (FAS) - (06/04)
Page: 2 of 6
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: CASTRO, TERESA
FACILITY NUMBER: 414004296
VISIT DATE: 03/19/2024
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
26
27
28
29
30
31
32
(Page 2)
During inspection, LPA reviewed bedroom #2. The children’s furniture inspected were free sharp corners or splinters. Napping supplies and materials were stored in closet. Per licensee, bedroom #2 will be used for napping and as an extra activity space when necessary.

At 11:50AM., LPA reviewed facility records including the children’s files and personnel files. The personnel files were reviewed and included staff’s: Proof of required Immunization; Acknowledgement to Report Suspected Child Abuse (LIC9102); and Mandated Reporter Training (AB1207).

Children’s files were reviewed and included their: Identification and Emergency Information (LIC700); Consent for Medical Treatment (LIC627); Notification of Parent’s Rights (LIC995); and Immunization Records.

LPA advised licensee of ensure families completed the Health History form (LIC702) prior to enrollment.

At 12:10PM., Based on record review and interview, LPA confirmed licensee is not documenting infant napping conditions during each 15-minute review.

Licensee’s Cardiopulmonary Resuscitation/ First Aid Certification (CPR) was current, expiring: 4/2025.
Licensee’s ‘Mandated Reporter Training’ certification (AB1207) was current, expiring: 2/1/2026.

Facility is conducting emergency disaster drill every 6 months with last drill completed on 2/28/2024, properly logged.

The required forms are posted in facility, including the Facility License; Notification of Parent’s Rights (PUB379); and Emergency Disaster Plan (LIC610A).

Per licensee, isolation of an ill child is in the playroom. Per licensee, parents provides snack and lunch services for children in care.


(REFER TO 809C, FOR CONT.)
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2024
LIC809 (FAS) - (06/04)
Page: 4 of 6
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: CASTRO, TERESA
FACILITY NUMBER: 414004296
VISIT DATE: 03/19/2024
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
26
27
28
29
30
31
32
(Page 3)
LPA offered to reviewed with license, the LIC311D, Records to Keep in Your Family Child Care Home, Children's Forms/ Records; Facility Forms/Records; and Information to be Posted. Licensee denied request. LPA left copy of required forms with licensee.

LPA and the licensee discussed licensing regulations and the capacity requirements. Any children under 10 years of age will be counted in the capacity.

Licensee was reminded that all adults 18 years and over living in the home, person who provides care and supervision to children, and staff who have contact with children, including employee and volunteers, except as specified in Health and Safety Code section 1596.871, 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 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 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.

Licensee was informed of the www.mychildcareplan.org site is a consumer education website that helps families obtain child care by connecting to child care providers and resources and referral agencies (R&R) throughout California.

Incidental Medical Services (IMS) policy was discussed. For IMS information, see PIN 20-02-CCP. When an IMS is provided, a plan for 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- 0382 (TTY) and link to publications: Commonly asked questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm
(REFER TO 809c, FOR CONT.)
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2024
LIC809 (FAS) - (06/04)
Page: 5 of 6
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: CASTRO, TERESA
FACILITY NUMBER: 414004296
VISIT DATE: 03/19/2024
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
26
27
28
29
30
31
32
(Page 4)
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 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, deficiencies were observed in areas evaluated according to California Title 22, Div. 12 Chap. 3, Health and Safety, Code of Regulations and cited on 809D. Exit interview, Plans or Correction; and Facility Evaluation Report was reviewed with Licensee, Teresa Flores. Licensee’s signature of this form acknowledges the receipt of these documents.

Prior to recommendation for increase of capacity, licensee must complete the following:
-Clear deficiencies issued during inspection
-Submit proof of required immunization for all adult in home.
-Submit Proof of Preventative Health and Safety Practices Course
-Submit the Pre licensing Readiness Guide (LIC9217)
-Completed the Earthquake Preparedness Checklist (LIC9148)

During exit interview, licensee, Teresa Castro confirmed that there are no registered sex offenders living in the facility, and LPA completed the RSO profile. Notice of site visit was given and must remain posted for 30 days.

This report must be available in the facility for public review. Notice was provided and shall remain posted for 30 days. The licensee was advised for additional questions to call CCL Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2024
LIC809 (FAS) - (06/04)
Page: 6 of 6