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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004973
Report Date: 02/03/2023
Date Signed: 02/16/2023 05:08:59 PM

Document Has Been Signed on 02/16/2023 05:08 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:PONCE-GONZALEZ, ELIZABETHFACILITY NUMBER:
414004973
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 6CENSUS: DATE:
02/03/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Elizabeth Ponce-GonzalezTIME COMPLETED:
01:30 PM
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On February 3, 2022, Licensing Program Analyst (LPA) Maria Olguin-Leon met with applicant Elizabeth Ponce-Gonzalez, for a scheduled pre-licensing inspection. Present for todays’ visit was current licensee Jose Alejandro Gutierrez (#414004863), two fingerprinted cleared adults (Magda & Melanie) and 6 children (2 infants & 4 preschool).

Applicant submitted family childcare home application to department on December 2, 2022. Current Licensee is retiring and applicant Elizabeth will be operating the facility from this day forward. The Applicant rents this single family 2- bedrooms and two bathroom home. The home residents is applicant and partner.

LPA and applicant inspected the indoors and outdoors of the home for health and safety hazards. Applicant rents single level home, that consist of a living room, sunroom, dining room, kitchen, 2 bedrooms and 2 bathrooms, garage, and backyard. The DAY CARE AREAS are Sunroom, bedroom #1(main playroom), dining room, living room. The OFF-LIMIT AREAS are the garage, kitchen, master bedroom, bathroom #2 (located in master bedroom). Outdoor play area is fenced of with plastic fence. The rest of backyard is off-limits and inaccessible. Doorways to kitchen are barricaded with child proof gates.

Home was clean and orderly with a variety of age-appropriate toys, books, and supplies available for children. Play area had child sized furniture. Applicant has playpen/cots/mats for napping. Sheets will be provided by applicant.
Cabinet in kitchen and bathroom are locked. Living room also includes a fireplace that is properly barricaded with a storage cubby unit and made inaccessible to children. Isolation area for sick children will be in the one of the dining room.
Discipline policy will be talking to children and redirecting children. Food services will be provided by applicant which will include breakfast, lunch, and 2 snacks.

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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE: DATE: 02/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/03/2023
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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: PONCE-GONZALEZ, ELIZABETH
FACILITY NUMBER: 414004973
VISIT DATE: 02/03/2023
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Home is equipped with fully charged 2A10BC fully fire extinguishers and a fully stocked first aid kit and thermometer. Applicants use a designated cell phone and is aware the cell phone must stay within the home during the day care hours. Applicant’s CPR & First Aid will expire 11/2024 and Mandated Reporter Certificate will expire 12/2023. Applicant has all required posting posted.

LPA reviewed the LIC311D, Records to Keep in Your Family Child Care Home, children’s forms/ records, facility forms, and information to be posted. Applicant CPR/First Aid certification is current and will expire 9/2024. Applicant’s Mandated Reporter training certificates (AB1207) are also current that will expire 07/2024.

LPA and applicants discussed licensing regulations and the capacity requirements. Any children under 10 years of age that live in the home, will be counted in overall capacity. Applicant were advised that all food containers brought from home must be properly stored and labelled. Applicants plan to provide a food service. LPA discussed sanitation and allergies with applicants.

Applicants understand the required emergency disaster drills are to be conducted and documented at least once every six months. Applicants understand that the use of baby walkers, bouncers, jumpers, and similar items are not to be used for children in care. Smoking is prohibited inside a Family Childcare Home.

Applicant was reminded 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.

Applicants were reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.



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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: PONCE-GONZALEZ, ELIZABETH
FACILITY NUMBER: 414004973
VISIT DATE: 02/03/2023
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LPA discussed the safe sleep regulations with applicants and discussed Child Care Licensing Safe Sleep webpage at:https://www.cdss.ca.gov/inforesource/child-care-licesning/public-information-and-resources/safe-sleep as an additional resource. LPA informed the applicants 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.

This facility plans to provide Incidental Medical Services-IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. A Plan for Providing IMS must be submitted to the Department. The following information regarding Americans with Disabilities Act (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: www.ada.gov/childqanda.htm.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important communication platform. To receive important license-related information to licensed facilities, visit the CCLD important information website at https://www.cdss.ca.gov/inforesources/community-care-lciensing/subscribe and select the Child Care option to receive email communication.

Prior to recommended licensure, following must be completed:

-bathroom vanity lock

-Living room outlet

-cable in sunroom

-safety latch on electrical outlet in sunroom

-door knobs of off-limits door/closet

Exit interview was conducted and report was reviewed with the applicant, Elizabeth Ponce-Gonzalez.







SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2023
LIC809 (FAS) - (06/04)
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