414004841-12-4-2024-05-CC-JTSE-DBMS4Q-20241204123308

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004841
Report Date: 12/04/2024
Date Signed: 12/04/2024 12:33:40 PM

Document Has Been Signed on 12/04/2024 12:33 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:	DIAZ, ELIZABETH		FACILITY NUMBER:	414004841
ADMINISTRATOR/ DIRECTOR:	DIAZ, ELIZABETH		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 445-5224
CITY:	MENLO PARK	STATE: CA	ZIP CODE:	94025
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 7	CENSUS: 5	DATE:	12/04/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:00 AM
MET WITH:	Licensee, Elizabeth Diaz		TIME VISIT/ INSPECTION COMPLETED:	12:45 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 12/4/2024, at approximately 9:00AM, Licensing Program Analysts (LPAs) Jonathan Tse and Katie Krenn conducted an unannounced annual visit at the facility. LPAs met with Licensee, Elizabeth Diaz and explained the purpose of the visit. Present during the visit was Licensee, one helper, four infants, and one preschool age child. The facility is in compliance with staffing and ratio requirements on this day. Daycare Areas: Living Room, Dining Room, Bedroom #2 (napping room), Bathroom #1, and Front Yard. Off-limits Areas: Kitchen, Bedrooms #1, 3, 4/Office, Bathroom #2, Garage, Side Yard and Backyard. LPAs and Licensee inspected the home for any health or safety hazards. There is a fully charged 3A40BC fire extinguisher present in the Living Room. There is an operational carbon monoxide detector present. LPAs observed a fire alarm system to be present. Off-limits areas are kept inaccessible to children in care with childproof gates. LPAs advised that the surface of the facility be kept free of debris and other loose articles. LPAs observed that soaps were stored in the Bathroom that would be accessible for children using the Bathroom on their own. LPAs advised that poisons, cleaning detergents, and other chemicals be stored inaccessible to children in care. Licensee stated that they understood. LPAs observed there to be age-appropriate toys and learning materials present. Furniture is age-appropriate and free of rough or sharp edges. There is one crib available for each infant in care. LPAs observed cribs to be in good repair, with mattresses equipped with tight-fitting sheets. Cots are also available for children to nap on. Bedding is provided by the facility. LPAs observed blankets placed in cribs during the visit. LPAs advised that blankets and sleep sacks are not to be used for infants in care. Licensee stated that they understood. The facility provides snacks and lunch for children in care. Lunch may also be provided from home. Continued on Page Two

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024

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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Document Has Been Signed on 12/04/2024 12:33 PM - It Cannot Be Edited

Created By: Jonathan Tse On 12/04/2024 at 11:36 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: DIAZ, ELIZABETH	FACILITY NUMBER: 414004841
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/04/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(9)(A)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review,, the licensee did not comply with the section cited above by not conducting an emergency drill within the past six months which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/18/2024
	Plan of Correction
1 2 3 4	Licensee stated they would complete an emergency drill, log it, and then send proof to LPA via email.

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above by not maintaining current Mandated Reporter Training, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/18/2024
	Plan of Correction
1 2 3 4	Licensee stated they would complete the training and then send proof to LPA 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:

Ali Zebila

LICENSING EVALUATOR NAME:

Jonathan Tse

LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024

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: DIAZ, ELIZABETH	FACILITY NUMBER: 414004841
	VISIT DATE: 12/04/2024

NARRATIVE

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Page Two
LPAs observed the Front Yard to be enclosed by a fence that is at least four feet high. LPAs advised that loose leaves and sand shall be removed from the play area. LPAs also advised that slides and containers be placed on their sides to avoid collecting standing water. Licensee stated that they understood. There are age-appropriate toys and equipment available for children in care. There are no pools or other similar bodies of water present in the facility. Per Licensee, there are no firearms or weapons stored in the home. There is a pet dog that is kept in off-limits areas during operating hours.

LPAs reviewed two staff files, five children’s files, and facility records. Licensee’s First Aid/CPR expires 8/2025. Licensee’s Mandated Reporter Training expired 2/2024. LPAs informed Licensee that a deficiency would be cited for expired Mandated Reporter Training. Licensee stated that they understood. Children’s files were observed to contain Emergency Identification and Information (LIC700) and Consent for Emergency Medical Treatment (LIC627). Infant sleeping logs were accessible and available for review. All required postings were observed to be posted and available for review in the Living Room. The facility last conducted an emergency drill on 2/2024. LPAs informed Licensee that a deficiency would be cited. Licensee stated that they understood.

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 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.

Continued on Page Three

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024

LIC809 (FAS) - (06/04)

Page: 8 of 9

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: DIAZ, ELIZABETH	FACILITY NUMBER: 414004841
	VISIT DATE: 12/04/2024

NARRATIVE

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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-andresources/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, Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

See LIC809-D for deficiencies cited today regarding Mandated Reporter Training and emergency drills. See LIC9102-TV for technical violations issued today regarding storage of soaps, childproof locks, loose articles and debris, sleep sacks, and blankets. See LIC9102-TA for technical assistance provided today regarding placement of cribs in the napping room. Appeal rights were provided and explained to Licensee. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Elizabeth Diaz.

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024

LIC809 (FAS) - (06/04)

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