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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004842
Report Date: 08/01/2023
Date Signed: 08/09/2023 11:37:58 AM

Document Has Been Signed on 08/09/2023 11:37 AM - 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:DAVILA, REGINA ELIZABETHFACILITY NUMBER:
414004842
ADMINISTRATOR:DAVILA, REGINA ELIZABETHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 209-6827
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94061
CAPACITY: 14TOTAL ENROLLED CHILDREN: 9CENSUS: 7DATE:
08/01/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:12 AM
MET WITH:Regina DavilaTIME COMPLETED:
12:00 PM
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On August 9, 2023, Licensing Program Analyst (LPA) Maria Olguin-Leon met with Licensee, Regina Davila for an unannounced annual inspection. The purpose of the inspection was explained. Present today was Licensee, licensee’s mom, 2 helpers, and 7 children (3 infants & 4 preschoolers). All adults have criminal record clearances on file with the department. Licensee is operating within capacity and ratio requirements on this day. Hours of operation are Monday– Friday, 8:00am to 5:00pm.

LPA and Licensee toured the home for health and safety hazards. Licensee rents this one-story, three-bedroom, 2-bathroom home. Day Care Areas: Living room, bathroom #1, bedroom #2 and bedroom #3 (used for napping purposes only) and backyard. Off Limits Areas: Kitchen, garage, bedroom #1 and bathroom #2. All cabinets are properly secured with childproof latches. Home is well light and has proper ventilation. Cleaning supplies and other potentially harmful items are stored inaccessible to the children. Fireplace is properly barricaded with and inaccessible to children. There are plenty of age-appropriate toys, books, child size furnishings, learning material, and sleeping mats and playpens. Backyard has plenty of age-appropriate play toys and is surrounded by a 5 ft fence. Backyard patio area is equipped with artificial grass, the rest of yard has grass to cushion falls. There are no spas, pools, or other bodies of water.

Home is equipped with a working carbon monoxide, smoke detectors, fire alarm system and a fully charged fire extinguisher. Isolation area for ill children will be in living room 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 sleeping cots and playpens and are washed weekly or when soiled. At 8:35 AM LPA observed a child sleeping in a playpen with a blanket next to child’s head, this is a potential risk to children in care and a Type B citation are issued for this deficiency. LPA observed infant with a pacifier attached to a clip, LPA issued a technical violation and reminded licensee of safe sleep practices.

Cont. page 2…
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE: DATE: 08/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/01/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 08/09/2023 11:37 AM - It Cannot Be Edited


Created By: Maria Olguin-Leon On 08/09/2023 at 10:42 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: DAVILA, REGINA ELIZABETH
FACILITY NUMBER: 414004842

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/01/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(b)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above as infant was sleeping in playpen with a folded blanket nesxt to their head, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/09/2023
Plan of Correction
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Licensee will make sure no items are in playpens while infant is sleeping. LPA discussed the importance of safe sleep regulations. Licensee will review safe sleep regulations and discuss with staff.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: 08/09/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/09/2023


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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: DAVILA, REGINA ELIZABETH
FACILITY NUMBER: 414004842
VISIT DATE: 08/01/2023
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LPA reviewed 6 children’s records and 2 staff record; all required documents were in files. Licensee Mandated Reporter training has expires 01/2025. Licensee’s CPR/First Aid is current and will expire on 09/2023. Licensee provides breakfast, lunch, and snacks to children in care. LPA reminded licensee that all bottles and food brought from home must be properly labelled with child’s name. Children’s roster was reviewed and is up to date. All required postings are posted and include Childcare License, Notification of Parent’s Rights (PUB379), and Emergency Disaster Plan (LIC610A), Last emergency drill was conducted on 05/23/2023 and is properly documented. Licensee has liability insurance through DCI /Accord and renewal is on 10/2023.

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/.

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. LPA reviewed AB 1207 with the Licensee.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023
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: DAVILA, REGINA ELIZABETH
FACILITY NUMBER: 414004842
VISIT DATE: 08/01/2023
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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. 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.

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.

During the exit interview, the LICENSEE Regina Davila, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

> See attached page for deficiency cited today.

>This report and rights to comment and appeal were discussed with Licensee, Regina Davila. This report must be available in the facility for public review. A notice of site visit was given and must remain posted for 30 days.
Licensee was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.cdss.ca.gov

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023
LIC809 (FAS) - (06/04)
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