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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004973
Report Date: 01/31/2024
Date Signed: 01/31/2024 03:51:40 PM

Document Has Been Signed on 01/31/2024 03:51 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:PONCE-GONZALEZ, ELIZABETHFACILITY NUMBER:
414004973
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 9CENSUS: 8DATE:
01/31/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Elizabeth Ponce-GonzalezTIME COMPLETED:
04:15 PM
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On January 31, 2024 at approximately 1:25PM, Licensing Program Analysts (LPAs) Maria Olguin-Leon and Janet Gil conducted an unannounced annual inspection in conjunction with a case management inspection for an increase of capacity. LPA met with Elizabeth Ponce-Gonzalez and purpose of inspection was explained. Licensee applied to increase capacity from a small to a large capacity license on January 16, 2024. Licensee’s one year anniversary as a small license childcare is on February 6, 2024. Present today was Licensee, two helper and 8 children (2 infant and 6 preschool age). LPA observed facility is operating over capacity limits. This is an immediate risk to children in care. A type A violation is issued this day for this deficiency. All adults working at facility have fingerprint clearance and are associated with facility. Facility hours of operation are from 8:00AM to 5:00PM.

LPAs and Licensee toured the home for health and safety hazards. Home is a one-story home. Day Care Areas: Living room, dining room, kitchen, bedroom #2, bathroom, shade room and backyard. Off Limits Areas: Master Bedroom, master bathroom and garage. Off limits areas are properly barricaded with closed doors. Childproof gates are located in living room, dining room and kitchen. Home is well light and has proper ventilation. Fireplace is properly barricaded with cubbies and inaccessible to children. Cleaning supplies and other potentially harmful items are stored inaccessible to children and behind child proof cabinets. All electrical outlets are secured with child proof covers. There are plenty of age-appropriate toys, books, child size furnishings, learning material, playpens and sleeping cots. Backyard has plenty of age-appropriate play toys, slide, ride on toys and playhouses. There is a canopy with sunshade located in backyard. Outdoor is equipped with a cement patio and artificial grass to cushion falls. A portion of the backyard is off limits and gated with childproof gates. The entire backyard is surrounded with a 5 ft. fence. LPA did not observe any spas, pools, or other bodies of water.

Home is equipped with a dual working carbon monoxide/smoke detector and a fully charged fire extinguisher. Fire alarm is in living room. Isolation area for ill children will be in area not in use and away from other children. LPAs reviewed first aid kit and kit is fully stocked. Licensee uses cell phone on the premises and understands phone must remain on premises during childcare hours. Per licensee, there are no weapons or firearms in the home. Licensee provides sheets for playpens and mats and are washed weekly or as needed.

Cont. page 2…
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: PONCE-GONZALEZ, ELIZABETH
FACILITY NUMBER: 414004973
VISIT DATE: 01/31/2024
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LPA reviewed 8 children’s records and 2 staff records. All children and staff records are complete. Licensee maintains an updated Children’s roster and sleep logs. Licensees CPR/FA expires 09/2025. Licensee Mandated Reporter training expires 07/2024. Licensee provides breakfast, lunch, and two snacks to children in care. LPA reminded Licensee to label children's food/bottles brought from home. LPA observed Childcare License, Emergency Disaster Plan (LIC610A) and Parent's rights posted. Last emergency drill was conducted on 12/09/2023 and is properly documented. Per Licensee, licensee carries liability insurance, LPA’s observed LIC282 in children’s files. LPA reviewed and provided Licensee capacity regulations.

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.

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/.

The Licensee was reminded about the Provider Information Notices (PINs) on the CCLD website. 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 against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662. LPA's reviewed AB 1207 with the Licensee.

As of January 1, 2018, all staff must complete Mandated Reporter Training every two years. LPA reminded licensee about Mandated Reporter training available www.mandatedreporterca.com


Cont. page 3...
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2024
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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: PONCE-GONZALEZ, ELIZABETH
FACILITY NUMBER: 414004973
VISIT DATE: 01/31/2024
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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. LPAs also informed licensees 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. LPA discussed sleep sacks.

The licensee provided proof of control of property. The licensee has not obtained a signed Property Owner/Landlord Consent form (LIC9149). Without this consent, the applicant understands that, once licensed, they can operate with a maximum capacity of 6 [or 12] children. If property owner/landlord consent is obtained in the future, the applicant is advised that a new Application for a Family Child Care Home License (LIC 279) must be submitted with a change of capacity fee of $25, to increase the capacity and provide care to 8 [or 14] children.

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 informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.



During the exit interview, the LICENSEE, Elizabeth Ponce-Gonzalez confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Cont.page 4...
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2024
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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: PONCE-GONZALEZ, ELIZABETH
FACILITY NUMBER: 414004973
VISIT DATE: 01/31/2024
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**See following page for deficiencies cited against the facility today under CCR, Title 22, Div. 12, Chapt. 1**

Type “A” violation was issued today. Licensee is advised to provide a copy of the Evaluation Report and all Type “A” Deficiencies cited, to the parents and guardians of children currently enrolled in care and to parents of newly enrolled children during the next 12 months. A signed and dated LIC 9224 shall be maintained in all Children's files.

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

LPAs will approve increase of capacity once the following conditions have bet met:
One year anniversary, 02/06/2024 and Fire inspection clearance has been approved.

Exit interview conducted and report was reviewed with the licensee, Elizabeth Ponce-Gonzalez.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2024
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Document Has Been Signed on 01/31/2024 03:51 PM - It Cannot Be Edited


Created By: Maria Olguin-Leon On 01/31/2024 at 03:24 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: PONCE-GONZALEZ, ELIZABETH
FACILITY NUMBER: 414004973

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/31/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102416.5(a)
Staffing Ratio and Capacity
(a) The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above. LPA confirmed Licensee is operating overcapacity with 2 infants and 6 preschooler in care, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 02/01/2024
Plan of Correction
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Licensee will submit TK enrollment for one child as proof child is enrolled in TK program. Licensee will have children alternate days for the next four day until increase of capacity is approved. LIcensee will submit children's schedules to LPA.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Marie Rodriguez
LICENSING EVALUATOR NAME:Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:
DATE: 01/31/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/31/2024


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