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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004868
Report Date: 05/17/2024
Date Signed: 05/17/2024 12:04:40 PM

Document Has Been Signed on 05/17/2024 12:04 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:SALDIVAR, YULYFACILITY NUMBER:
414004868
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 10CENSUS: 6DATE:
05/17/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Licensee, Yuly SaldivarTIME VISIT/
INSPECTION COMPLETED:
12:25 PM
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On May 17th, 2024, at approximately 8:30am, Licensing Program Analyst (LPA) Tapia-Mandujano arrived at the facility to conduct an annual inspection and an Case Management initiated by licensee. LPA explained the purpose of the inspection. LPA met with licensee, Yuly Saldivar. Present in the facility were licensee and licensee's assistant supervising 6 children (2 infants and 4 preschool age). Facility is operating within capacity limits on this day. All adult living and working in the home are fingerprint cleared and associated.

Licensee has requested to expand license from a Small to a Large Family Child Care Home. Fire Clearance was received by Menlo Park Fire Department on 4/22/24. During today's inspection, LPA went over Capacity limitations with licensee. LPA provided Capacity Worksheet to licensee.

Licensee has also requested to approve a portion of the front yard. LPA inspected the front yard for potential hazards. Front yard is divided by a play yard gate. Front yard usage includes the playground area and the concrete area. All potential hazards are gated off. LPA reminded licensee about water safety regulations and best practices. Front Area appears to be clean and contains age-appropriate toys. Front yard does have a playground that can only be used for children between 3-10 years old. LPA reminded licensee that all emergency exits must be free of objects and accessible at all times.

Licensee's family own the two story home. Licensee lives with 4 other adults and 3 minor children. The hours of operation are Monday-Friday 8:30am-5pm. New Daycare areas are: First Floor: Living room, bathroom #1, Portion of the Front Yard, and backyard. Off-limit areas are: First Floor: Kitchen, Laundry room/garages, Second Floor: Bedrooms #1&2, Bathroom #2. All off limit areas, including closets, are properly barricaded.

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SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE: DATE: 05/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/17/2024
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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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: SALDIVAR, YULY
FACILITY NUMBER: 414004868
VISIT DATE: 05/17/2024
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LPA toured day care areas of home with Licensee. 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 does not have a fire place in the home. There were no pools, spas or bodies of water on the property. Licensee has a pet dog that has all the proper documentation. 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. Fire alarm was installed in the living room wall. Emergency exits will be the front door and through the back patio door. Phone number listed for Licensee is current. Per Licensee, there are no weapons or firearms in the home.

LPA reviewed 6 children’s records which were complete. LPA also reviewed facility and employee records. Licensees CPR & First Aid Certificate expires on 01/2026. Licensee's Mandated Reporter Training expires on 03/2026. Last emergency drill was conducted 11/27/2023. Licensee is aware that she is due for an emergency drill this month. Emergency drills are conducted at least once every six months and are properly logged.

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, 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.


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SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2024
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: SALDIVAR, YULY
FACILITY NUMBER: 414004868
VISIT DATE: 05/17/2024
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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-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. Licensee does not have any children enrolled who use medication. 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, Yuly Saldivar confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS on 05/17/2024.

No Deficiencies were cited today under CCR, Title 22, Div. 12, Chapt. 1.

LPA has approved the Large Family Child Care home as of today, May 17th, 2024.

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

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

DATE: 05/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2024
LIC809 (FAS) - (06/04)
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