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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004705
Report Date: 08/24/2023
Date Signed: 08/24/2023 02:44:18 PM

Document Has Been Signed on 08/24/2023 02:44 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:PELAEZ, SILVIAFACILITY NUMBER:
414004705
ADMINISTRATOR:PELAEZ, SILVIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 679-4440
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94063
CAPACITY: 14TOTAL ENROLLED CHILDREN: 3CENSUS: 3DATE:
08/24/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Licensee, Silvia PelaezTIME COMPLETED:
03:00 PM
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On August 24th, 2023 at 1:10PM, Licensing Program Analyst(LPA) Tapia-Mandujano conducted a Random Annual unannounced inspection at facility and met with licensee, Silvia Pelaez. Purpose of the inspection was explained. Present in the home is licensee, licensee's son and daughter. Licensee is caring for 3 preschool age children. All adults living and working have fingerprint clearance are associated.

Licensee owns home, which is a 3 bedroom, 2 bathroom, single level (front) Duplex. Hours of operation are Monday-Friday from 8AM-5PM. Daycare area is: Living Room, Bedrooms #1, #2, and #3, Dining area, Family Room/Playroom, Bathroom#1 & 2, Side yard, and Deck. OFF limit areas: Front yard, Kitchen, Garage, and Backyard (pass by only). All off limit areas are properly barricaded.

LPA toured day care areas of home with Licensee to inspect for health and safety hazards. LPA observed home to be clean and in good repair with proper temperature and ventilation. There were a variety of age appropriate toys and equipment in the home which were in good condition. Home has a fireplace that is properly barricaded. Per licensee, there is one pet dog. There are no pools, and bodies of water in the premises. All cleaning supplies, poisons and other chemicals were stored inaccessible to children. Discipline Policy was discussed.

There was a fully charged fire extinguisher, smoke alarm and carbon monoxide alarm, and a working telephone on site. Phone number listed for Licensee is current. Per Licensee, there are no weapons or firearms in the home. LPA reviewed three children's record. LPA also reviewed facility and personnel records. LPA found that records are complete. Licensees CPR & First Aid Certificate will expire 06/2024. Licensee's mandated reporter training will expire on 07/2024. Last Emergency drill was on 06/2023. Emergency drills must be conducted at least once every six months and should be properly logged.

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SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE: DATE: 08/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/24/2023
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: PELAEZ, SILVIA
FACILITY NUMBER: 414004705
VISIT DATE: 08/24/2023
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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 Child Care Center. 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. 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/.

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, Silvia Pelaez, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS on 8/24/2023.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Silvia Pelaez.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023
LIC809 (FAS) - (06/04)
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