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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004688
Report Date: 06/28/2022
Date Signed: 06/28/2022 04:22:44 PM

Document Has Been Signed on 06/28/2022 04:22 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:BRAVO, JULIA A.FACILITY NUMBER:
414004688
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
06/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Julia BravoTIME COMPLETED:
04:35 PM
NARRATIVE
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On 6/28/2022 at 1:50PM., Licensing Program Analyst (LPA), Luis J. Gomez met with Licensee, Julia Bravo. Purpose of the inspection was explained and was for an unannounced; annual random inspection. Present in facility was the licensee and son caring for two children (1 Infant age 1 School age). Per licensee, son is providing local in-home childcare services for school age child, and will not be staying. Adults present have their criminal record clearances on file. Licensee’s home is a two bedroom, one bathroom, one level unit. Days and hours of operation are: Monday- Friday; 8:00am- 5:00pm. Daycare areas are: Living Room (Playroom #1), Garage, Bedroom #1, Bathroom and Outdoor Play Yard Off Limit areas are: Bedroom #2 and Kitchen (Pass through only). LPA inspected home, inside and outside, with the licensee for health and safety hazards.

At 2:00PM., the following was observed: home was clean, orderly, and with age-appropriate toys available for the children. Playthings and furniture inspected were in good repair and free of any sharp edges. Playroom and bedroom #1, were equipped with soft padding for added fall safety. For napping services, cribs and napping mats are stored in bedroom#1. Mattresses inspected were the proper size. Licensee had at least one crib available for infant in care. Bathroom was observed clean and with supplies. Bathroom fixtures tested were in proper order. Off-limit areas been made inaccessible with child safety gate. Accessible outlets and trash bins had been covered. Cleaning detergents, compounds, wipes, spray bottles and items which could pose a danger, were stored inaccessible to day-care children. Facility was the proper temperature, with ventilation and lighting. Home had functioning telephone; smoke/ carbon monoxide detector; and one fully charged fire extinguishers; 3A:40BC. (REFER TO 809C FOR CONT.)
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 06/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/28/2022
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 06/28/2022 04:22 PM - It Cannot Be Edited


Created By: Luis Gomez On 06/28/2022 at 03:10 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: BRAVO, JULIA A.
FACILITY NUMBER: 414004688

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/28/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102421(b)
Child's Records
(b) The licensee shall maintain, in each child's record, a copy of the emergency information card as required
in Section 102417(g)(7).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, LPA confirmed licensee was missing Identification of Emergency Information (LIC700) for infant age child (C1) in care. This poses an potential health and safety risk to children in care.
POC Due Date: 07/08/2022
Plan of Correction
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Licensee will submit infant child's (C1) updated LIC700 to the Department prior to the due date: 7/8/2022.

Licensee will submit proof of correction via email.
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and interview, LPA confirmed licensee was missing Individual Infant Sleeping Plan (LIC9227) for qualifying infant (C1) in care. This poses a potential health and safety risk to children in care.
POC Due Date: 07/08/2022
Plan of Correction
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Licensee will submit infant child's (C1) updated LIC9227 to the Department prior to the due date: 7/8/2022.

Licensee will submit proof of correction via email.
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:Cindy Interiano
LICENSING EVALUATOR NAME:Luis Gomez
LICENSING EVALUATOR SIGNATURE:
DATE: 06/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/28/2022


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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: BRAVO, JULIA A.
FACILITY NUMBER: 414004688
VISIT DATE: 06/28/2022
NARRATIVE
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(Page 2)
At 2:15AM, LPA inspected Outdoor Play Area. Outdoor area was completely enclosed and free of debris. Play items inspected where in good repair. Outdoor area had sufficient shading available for the children. LPA advice licensee to put away leaf blower and accessible gardening supplies. Home did not have any swimming pools, spas, hot tubs, fishponds or other bodies of water.

At 2:25AM., LPA reviewed the facility and children’s records.

At 2:35PM, Based on record review, LPA confirmed licensee's mandated reporter training certification had expired. Advisory Note: Technical Violation was issued (LIC9102TV).

At 2:37PM., Based on record review, LPA confirmed licensee was missing Identification of Emergency Information (LIC700) for infant age child (C1) in care.

At 2:40AM., Based on interview and record review, LPA confirmed licensee missing Immunization Records for infant child (C1) in care. Advisory Note: Technical Assistance was issued.

At 2:44PM, Based on record review and interview, LPA confirmed licensee was missing Individual Infant Sleeping Plan (LIC9227) for qualifying infant (C1) in care.

LPA reminded licensee to maintaining infant napping logs, with documentation of each 15-minute check. Provider's Cardiopulmonary Resuscitation (CPR)/ First Aid Certification was current, expiring 3/2024.

At 2:30PM. Based on record review, LPA confirmed licensee is not documenting emergency disaster drills every six months. Advisory Note: Technical Violation was issued (LIC9102TV).

LPA observed postings including: Facility Childcare License, Notification of Parent’s Rights, and Emergency Disaster Plan. Children's Roster (LIC500) was reviewed during inspection. Per licensee, isolation of an ill child is in the playroom.

Per licensee, facility provides all lunch and snack for children in care. LPA's asked staff to ensure all children’s food containers brought to facility by families are properly labelled. Per licensee, home does not have any no guns or weapons. (REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2022
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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: BRAVO, JULIA A.
FACILITY NUMBER: 414004688
VISIT DATE: 06/28/2022
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(Page 3)
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 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.

To improve the quality and value of the new inspection process, a survey will 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, Health and Safety Code of Regulations. Exit interview, report and plan of correction was reviewed with Licensee, Julia Bravo and signature of this form acknowledges receipt of these documents.



Notice of Site Visit was provided and must remain posted for 30 days.

This report must be available in the facility for public review. Licensee was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2022
LIC809 (FAS) - (06/04)
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