414004876-10-2-2023-05-CC-LGOZ-CW8VCH-20231002161909

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004876
Report Date: 10/02/2023
Date Signed: 10/02/2023 04:19:14 PM

Document Has Been Signed on 10/02/2023 04:19 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:	LOPEZ GUZMAN, DAISY N.		FACILITY NUMBER:	414004876
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 1	DATE:	10/02/2023
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	01:55 PM
MET WITH:	Daisy Lopez		TIME COMPLETED:	04:25 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 10/2/2023 at 1:55PM., Licensing Program Analysts (LPAs), Luis J. Gomez, and Man Tso met with Licensee, Daisy Lopez Guzman. Purpose of inspection was explained and was for an Unannounced; Case Management inspection for Increase of Capacity; and Room Change/ Addition. Per licensee, her bother (Adult) is visiting in the off-limit areas (studio unit) Present was the licensee, helper caring for one child. Child present is infant age. Home is a 3 bedroom, 2 bathroom, one level townhouse. Days and hours of operations are: Monday- Friday, 8:00 AM., to 5:30 PM. Day-care Areas are: Living Room (Playroom), Bedroom #1 (Napping only), Dining Room, Bathroom #1 and the Outdoor Play Area (Patio). Off-limit Area are: Bedroom #2, Bedroom #3, Bathroom #2, Garage Area, #1 (Pass through only), Garage Area #2 (Pass through only), Garage Area #3/ Studio unit, Kitchen (Pass through only) and Laundry Area. LPA inspected home, indoors and outdoors, with licensee for health and safety hazards. At 2:05PM., the following was observed: Facility was clean, orderly, with age-appropriate playthings and materials available for the children. Toys and books inspected were in proper repair. Cubbies are available for storage of children belongings. The off-limit areas have been made inaccessible. Licensee has child size tables and chairs for seated activities. Bathroom #1 was clean, with fixtures in operating condition. Diaper changing table is located in playroom. For napping services, LPA observed several mats stored in the playroom. Infant cribs were equipped with tight-fitting sheet and mattress. Facility has sufficient ventilation and lighting. Facility has a functioning cell phone, smoke/ carbon monoxide combination detector and fire extinguisher (2A10BC). Detergents; toxins; cleaning compounds; and items (which could pose a danger) are stored in the off-limit areas. At 2:30PM., LPAs inspected the outdoor play area (Patio). Patio was completely enclosed, with playthings inspected in good repair. Home did not have pools, fishponds, spas, jacuzzi or any other bodies of water. (REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2023

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: LOPEZ GUZMAN, DAISY N.	FACILITY NUMBER: 414004876
	VISIT DATE: 10/02/2023

NARRATIVE

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(PAGE 2)
During inspection, LPAs reviewed Bedroom #1 and Dining Room for health and safety hazards. Bedroom #1 has several infant cribs available. Per licensee, bedroom #1 will be used for napping only.

LPAs reviewed facility records, including 1 child's and 1 personnel record.

At 2:55PM., Based on record review, LPA confirmed, staff present, S1, missing required Mandated Reporter Training certification (AB1207) from facility records. Advisory Note: Technical Violation (LIC9102TV) was issued.

Licensee’s Cardiopulmonary Resuscitation / First Aid certification is current, expiring on: 2/2024.
Licensee’s Mandated Reporter Training Certification (AB1207) is current, expiring on: 9/8/2025.

Per Licensee, she will provide daily snacks and meals. Isolation of an ill child will be in the hallway. Per licensee, home does not have any firearms or weapons. Licensee has a pet cat.

Per licensee, last fire drill was conducted on 9/1/2023. LPA reminded licensee to document each disaster drill conducted. Advisory Note: Technical Violation (LIC9102TV) was issued.

Required forms are posted in entry way include the: Facility license; Notification of Parent’s Rights (PUB294); and Emergency Disaster Plan (LIC610A).

Licensee was informed that the Department must be notified prior to the use of designated off-limits areas. LPA and the licensee discussed licensing regulations and the capacity requirements. Any children under 10 years of age will be counted in the capacity. Licensee was advised that all food containers brought from home must be properly stored and labeled. Licensee understands the required emergency disaster drills are to be conducted and documented every six months. Licensee understands that the use baby walkers, bouncers, jumpers and similar items are not to be used for children in care. Smoking is prohibited inside a Family Childcare Home. (REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2023

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: LOPEZ GUZMAN, DAISY N.	FACILITY NUMBER: 414004876
	VISIT DATE: 10/02/2023

NARRATIVE

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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 for influenza, pertussis and measles or qualifies for an exemption pursuant to Health and Safety Code 1596.7995 and 1597.662.

Licensee was reminded that all adults 18 years and over living in the home, person who provides care and supervision to children, and staff who have contact with children, including employee and volunteers, except as specified in Health and Safety Code section 1596.871, 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 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.

The licensee provided proof of control of property and because licensee rents/ leases home, proof of landlord notification is required. The licensee obtained a signed Property Owner/ Landlords Consent form (LIC9149).
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.

Licensee was informed of the Mychildcareplan.org site, a consumer education website that helps families obtain childcare by connecting to childcare providers and resources and referral agencies (R&R) throughout California.

During inspection licensee submitted the updated LIC999, Updated Facility Sketch.
Fire Clearance Approval (STD850) was received on 9/5/2023.

Prior to recommendation for approval of Increase in Capacity/ Room Additions, licensee must complete the following:
Make water heater and dryer next to kitchen inaccessible.
Install child safety lock on kitchen drawers.
Remove all potential hazards from garage area #2.

**No deficiencies were cited against the facility today under CCR, Title 22, Div. 12, Chapter. 3**

Exit interview was conducted and report was reviewed with Licensee, Daisy Lopez. Copy of report was provided to licensee. This report will be kept in facility file and made available for public review upon request. Desk Duty is available Monday- Friday between 8AM - 5PM at (650) 266 -8800.

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2023

LIC809 (FAS) - (06/04)

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