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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004876
Report Date: 10/17/2024
Date Signed: 10/17/2024 03:13:39 PM

Document Has Been Signed on 10/17/2024 03:13 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/
DIRECTOR:		LOPEZ GUZMAN, DAISY N.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 520-1249
CITY:SAN MATEOSTATE: CAZIP CODE:
94402
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
10/17/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:10 PM
MET WITH:Licensee, Daisy Lopez GuzmanTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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On October 17, 2024, at approximately 1:10 pm, Licensing Program Analyst (LPA) Melissa Zaragoza conducted an unannounced, annual inspection. LPA was greeted and granted access by licensee, Daisy Lopez Guzman. At the entrance licensee was explained the purpose of the inspection. Present during LPA's visit included licensee, one staff assistant, and 4 children (2 infants and 2 preschool).

Hours of operation are Monday through Friday 8:00am to 5:30pm. Licensee lives in a one-level home with their spouse and adult sons. All adults living in the home and staff present, have fingerprint clearance on file.

The DAY CARE AREAS are the living room, bedroom #1(napping room), bathroom #1, dining room, and outdoor play area (patio). The OFF LIMIT AREAS the kitchen (walk through only), bedroom#2, bedroom #3, bathroom #2, garage #1 (entrance/pass through only), garage Area #2 (Pass through only), and laundry Area. Off limit areas are made inaccessible with child safety gates.

LPA toured day care areas of home with the licensee. LPA observed home to be in good repair with proper temperature and ventilation. Home is equipped with a variety of toys and materials that were observed to be in good condition. LPA observed electrical outlets to be made inaccessible with child safety covers. Cleaning supplies, poisons and hazardous materials are stored in home's high shelves and/or locked behind child safety locked cabinets.

Home is equipped with a fully charged fire extinguisher and a smoke and carbon monoxide detector. Smoke and carbon monoxide detectors were tested during visit and was observed to be in working condition.There are no pools, and bodies of water in the premises.

Napping area (bedroom #1) was observed to be equipped with a playpens and mats for napping children. Playpen was observed to be free of loose articles, bumper pads and pillows. LPA observed playpens to have mattresses with tight fitting sheets. Per licensee, sheets and blankets are not used in day care.
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SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE: DATE: 10/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/17/2024
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: LOPEZ GUZMAN, DAISY N.
FACILITY NUMBER: 414004876
VISIT DATE: 10/17/2024
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Bathroom was observed to be in proper working condition. There is appropriate sanitation and toileting equipment for children in care. LPA observed children’s diapers and wipes in napping room, stored in the changing table. Per licensee, children’s families provide diapers and wipes for enrolled children.

Per licensee, there are no children with dietary restrictions and allergies. Per licensee, they provide a food service, of breakfast, lunch, and two snacks. LPA observed knives to be made inaccessible with child safety locks.

LPA observed outdoor patio to have toys and materials for children to play with that were observed to be in good condition. LPA observed outdoor play area to have fake grass flooring. LPA observed an umbrella used for shade. Outdoor area to be fully fenced. LPA did not observe any pools or bodies of water.

LPA reviewed 4 children records which were complete. LPA reviewed licensee’s and staff records which were complete. Licensee has a current CPR/First Aid certifications and current Mandated Reporter certification. Licensee's CPR/First Aid certification will expire on 09/2025 and Mandated Reporter certification will expire 04/22/2026.

Emergency disaster drills are conducted and are appropriately documented. Last disaster drill was conducted 09/05/2024. LPA observed licensing documentation to be properly posted, made available for review. Facility maintains a childcare roster that was also made available for review. Per licensee, there are no weapons or firearms in the home.

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.
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SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2024
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: LOPEZ GUZMAN, DAISY N.
FACILITY NUMBER: 414004876
VISIT DATE: 10/17/2024
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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.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://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, the licensee, Daisy Lopez Guzman, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed a Megan’s Law search on 10/2/24.

No deficiencies were issued during today's visit. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Daisy Lopez Guzman.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2024
LIC809 (FAS) - (06/04)
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