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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004558
Report Date: 05/24/2023
Date Signed: 05/31/2023 02:10:35 PM

Document Has Been Signed on 05/31/2023 02:10 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:PISSANI, MIGUEL A.FACILITY NUMBER:
414004558
ADMINISTRATOR:PISSANI, MIGUEL A.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 533-7213
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94061
CAPACITY: 14TOTAL ENROLLED CHILDREN: 9CENSUS: 7DATE:
05/24/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:52 AM
MET WITH:Miguel PissaniTIME COMPLETED:
12:50 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 5/24/23, Licensing Program Analyst (LPA) Maria Olguin-Leon conducted a Case Management. The purpose of this inspection is to cite facility for not following Safe sleep regulations and over capacity. Present in the facility is Licensee, two helper and 7 children (4 infants & 3 preschoolers) LPA and Licensee inspected the facility for health and safety hazards.

On 04/26/2023, LPA conducted a Case management visit and observed deficiencies. Based on LPA observations, file reviews, and interview, facility did not follow safe sleep regulations, children shall not be forced to stay in a designated sleeping area, which poses a potential risk to children in care. A Type “B” violation was issued today in accordance to the California Code of Regulations, Title 22, Division 12, Chapter 1, citation was being cited on the attached LIC809D.

Based on LPA observations and interview, facility did not follow safe sleep regulations, the door from the room where infants are sleeping shall remain open at all times, which poses a potential risk to children in care. A Type “B” violation was issued today in accordance with the California Code of Regulations, Title 22, Division 12, Chapter 1, citation was being cited on the attached LIC809D. Safe Sleep regulations have been discussed with licensee.

Based on LPA observation, record review, Licensee was over capacity with 5 infants present. A type “A” violation is issued for over capacity limits. Please see attached 809D.

Licensee, Miguel Pissani was informed that this report dated May 26, 2023, documents one Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE: DATE: 05/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/24/2023
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 4
Document Has Been Signed on 05/31/2023 02:10 PM - It Cannot Be Edited


Created By: Maria Olguin-Leon On 05/24/2023 at 11:19 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: 05/24/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/25/2023
Section Cited
CCR
102425(e)

1
2
3
4
5
6
7
102425(e) Infant Safe Sleep. No Infant may be forced to sleep, to stay awake, or to stay in the designated sleeping area. This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Licensee stated he will remove coverings and place curtains in room by 04/27/2023. Proof of correction will be submitted to the department via email.
8
9
10
11
12
13
14
At 3:16PM., Based on observations, LPA confirmed infant playplens were completely covered with a black covering, forcing them to stay in designated sleeping area. This poses a potential health and safety risk to children in care.
8
9
10
11
12
13
14
Type B
05/25/2023
Section Cited
CCR102325(j)(5)

1
2
3
4
5
6
7
102325 (j)(5) If the infant is sleeping in a separate room from where the provider is stationed, the door from the room the infant is sleeping in shall remain open at all times.

1
2
3
4
5
6
7
Licensee stated door will remain open during nap time to be able to observe and see children when napping
8
9
10
11
12
13
14
At 3:15PM, Based on observations, LPA confirmed door to napping room was closed with 5 children in covered playpens. This poses a potential health risk to children in care.
8
9
10
11
12
13
14
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:Ali Zebila
LICENSING EVALUATOR NAME:Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:
DATE: 05/24/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/24/2023


LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 05/31/2023 02:10 PM - It Cannot Be Edited


Created By: Maria Olguin-Leon On 05/24/2023 at 11:33 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: 05/24/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/25/2023
Section Cited
CCR
102416.5(a)

1
2
3
4
5
6
7
102416.5(a) Staffing Ratio and Capacity: The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time. This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licensee will only accept 4 infant daily and turn away drop ins. Licensee will submitt names of children currently enrolled and childrens weekly schedule by due date: 5/25/2023.

Updated schedule will be submitted to the Department via email.
8
9
10
11
12
13
14
Based on interviews, observations, record review; LPA confirmed licensee was operating overcapacity with five infants in care. This poses an immediate health and safety risk to children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Ali Zebila
LICENSING EVALUATOR NAME:Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:
DATE: 05/24/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/24/2023


LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: PISSANI, MIGUEL A.
FACILITY NUMBER: 414004558
VISIT DATE: 05/24/2023
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
LPA informed the licensee to provide a copy of this licensing report date 05/24/2023 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

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, appeal rights given and report was reviewed with the licensee, Miguel Pissani.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023
LIC809 (FAS) - (06/04)
Page: 4 of 4