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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004558
Report Date: 04/11/2024
Date Signed: 04/11/2024 12:23:56 PM

Document Has Been Signed on 04/11/2024 12:23 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:PISSANI, MIGUEL A.FACILITY NUMBER:
414004558
ADMINISTRATOR/
DIRECTOR:		PISSANI, MIGUEL A.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 533-7213
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94061
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 8DATE:
04/11/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:02 AM
MET WITH:Miguel PissaniTIME VISIT/
INSPECTION COMPLETED:
12:40 PM
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On April 11, 2024 @ approx. 9:00 am, Licensing Program Analyst (LPAs) Maria Olguin-Leon & Melissa Zaragoza met with Licensee, Miguel Pissani for an unannounced annual inspection. The purpose of the inspection was explained. Present today was Licensee, two helpers, and 8 children (2 infants & 6 preschool age). All adults present in home have criminal background clearances. Licensee is within capacity/ratios on this day. Daycare hours are Monday– Friday, 8:00 am - 5:00pm.

LPAs and Licensee toured the home for health and safety hazards. The home is a single level two-bedroom home. Day Care Areas: Living room, dining room, daycare room, bathroom, bedroom #2(napping room only) and backyard. Off Limits Areas: Kitchen, bedroom #1 and garage. Home is well light and has proper ventilation. Kitchen and bathroom cabinets are equipped with childproof locks. Kitchen is equipped with a childproof gate. Cleaning supplies and other potentially harmful items are stored inaccessible to the children. All electrical outlets are properly covered. There are plenty of age-appropriate toys, books, child size furnishings, learning material, highchairs, cubbies, and playpens, all in good condition. LPAs observed a changing table in living room. LPA observed backyard to have ride on toys, playhouse, and play slide. Outdoor backyard is equipped with artificial grass to cushion falls. Backyard is surrounded with a 5 ft. fence. Right side of backyard is off limits and equipped with a 2 ft. gate. LPAs did not observe any spas, pools, or other bodies of waters.

Home is equipped with a working smoke detector, carbon monoxide detector and a fully charged fire extinguisher. Isolation area for ill children will be in living room area and away from other children. First aid kit is fully stocked with supplies. Licensee uses a cell phone on the premises. Per licensee there are no weapons or firearms in the home. Licensee provides sheets for playpens and are washed weekly or when soiled.

Cont. page 2...
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE: DATE: 04/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/11/2024
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: PISSANI, MIGUEL A.
FACILITY NUMBER: 414004558
VISIT DATE: 04/11/2024
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At approx. 9:00 am, LPA observed 7 children sitting in highchairs in daycare room participating in circle/learning time. Highchair was not being used for intended purpose, restricting children’s movement. Child #8 arrived at approx. 9:21 am and seated in highchair and then carried into daycare room to participate in circle/learning time. LPAs observed children removed from highchairs at approx. 9:40 am to go outside. One child sitting in highchair was pick up in chair and transported outside. Type B deficiency is being issued on this day in accordance with the California Code of Regulations, Title 22, see LIC809D.

LPA reviewed 8 children’s records and 2 staff record. Two children’s files were missing LIC9224, Type B deficiency issued. Licensee CPR/FA expires 02/2026. Licensee Mandated Reporter training expires 08/2025. Licensee provides Breakfast, Lunch, and snacks for children in care. LPA reminded Licensee to label children's food/bottles brought from home. LPA observed Childcare License, Emergency Disaster Plan 610A and Parent's rights posted at entrance of home. Last emergency drill was conducted on 10/2023 and is properly documented.

Licensee was reminded that all adults 18 and over living or working in the home, 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 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.

Incidental Medical Services (IMS) policy was discussed. 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/

Cont. page 3...
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024
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: PISSANI, MIGUEL A.
FACILITY NUMBER: 414004558
VISIT DATE: 04/11/2024
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The Licensee was reminded about the Provider Information Notices (PINs) on the CCLD website. 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.

As of January 1, 2018, all staff must complete Mandated Reporter Training every two years. LPA reminded licensee about Mandated Reporter training available www.mandatedreporterca.com

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. LPAs also informed licensee [or facility representative] 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.

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



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.

Cont. page 4...
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024
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: PISSANI, MIGUEL A.
FACILITY NUMBER: 414004558
VISIT DATE: 04/11/2024
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During the exit interview, the LICENSEE, Miguel Pissani confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS on 04/02/2024.

There were two deficiencies cited during today inspection. See page LIC809D for deficiencies.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee Miguel Pissani.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/11/2024 12:23 PM - It Cannot Be Edited


Created By: Maria Olguin-Leon On 04/11/2024 at 11:30 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: PISSANI, MIGUEL A.
FACILITY NUMBER: 414004558

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/11/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102423(a)(2)
Personal Rights
(a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following: (2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations, the licensee did not comply with the section cited above by placing children in care in high chairs for circle time for approx. 40 minutes and did not use high chair for it intended purpose only, which poses a potential health, safety or personal rights risk to children in care.
POC Due Date: 04/11/2024
Plan of Correction
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Licensee will only use high chairs for its intended purpose (eatsing meals).
Type B
Section Cited
HSC
1596.8595(a)(1)


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, LPAs did not observe signed copies of LIC9224 for 2 out 8 children enrolled, as this was unable to see a copy of signed LIC 9224 for each child that attends facility as there were no files for any of the children present, which poses a potential health, safety or personal rights risk to children in care.
POC Due Date: 04/18/2024
Plan of Correction
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Licensees must obtain signatures on the LIC 9224 and maintain a copy of the form in each child's file.
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:Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:
DATE: 04/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/11/2024


LIC809 (FAS) - (06/04)
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