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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004916
Report Date: 10/25/2023
Date Signed: 10/25/2023 02:49:30 PM

Document Has Been Signed on 10/25/2023 02:49 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:CHAVEZ, MARISOLFACILITY NUMBER:
414004916
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
10/25/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Licensee, Marisol ChavezTIME COMPLETED:
03:05 PM
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On October 25th, 2023 at approximately 1:35pm, Licensing Program Analyst's (LPAs) Tapia-Mandujano and Tse conducted an unannounced inspection for increase of capacity today and met with licensee, Marisol Chavez for her request to increase from a Small license to a Large Family Child Care license. Fire Clearance was received by Menlo Park Fire Department on 10/19/23. Present in the home are licensee, licensee’s mom, and licensee’s school age children over 10 years of age. Licensee is supervising 3 infants. Licensee is within capacity limits on this day. All adults living and working in the home have fingerprint clearance and are associated to the facility.

Licensee rents home, which is a two-bedroom one bathroom house with front and backyard, and garage. Licensee lives in home with two other adults and two minor children. The hours of operation are Monday-Friday from 8am-5pm. LPAs inspected for health and safety hazards. Daycare areas are: Living Room, Dining Room, Bathroom #1, and portion of the backyard. OFF limit areas are: Kitchen, Bedroom #2, front yard, driveway, and garage. All off limit areas are properly barricaded.

LPA observed home to be clean and in good repair with proper temperature and ventilation. There is a variety of age-appropriate toys and equipment in the home which are in good condition. There are no pools, spas, or bodies of water on the property. Home has a fireplace that is properly barricaded. Infant children have pack and plays to sleep in. Licensee was reminded of the Safe Sleep Regulations on this date. All cleaning supplies, poisons, and other chemicals are stored inaccessible to children. LPAs observed fire alarm installation on the living room wall by entrance with evacuation plan. There is a fully charged fire extinguisher, and a working telephone. Backyard is fenced and properly barricaded. Evacuation exit is the Right Sideyard that leads to the front of the house. Per Licensee, there are no weapons or firearms in the home. Per licensee, there are no pets in the home. Licensee's CPR & First Aid expires on 12/2023. Licensee's Mandated Reporter certificate expires on 07/2024. Important Postings were posted near main door. Licensee is reminded of NO walker, exersaucers, jumpers, bouncers and any similar items to be used for children in care and shall be made inaccessible. Capacity limits of a Small and Large Family Child Care Home were explained.

LPA will reccommend for approval of a Large Family Child Care Home License as of today, October 25th, 2023.

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

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

Exit interview was conducted and report was reviewed by licensee, Marisol Chavez.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE: DATE: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/25/2023
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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