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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004987
Report Date: 02/21/2023
Date Signed: 02/21/2023 12:50:01 PM

Document Has Been Signed on 02/21/2023 12:50 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:PADILLA, MARISOLFACILITY NUMBER:
414004987
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
02/21/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Applicant, Marisol PadillaTIME COMPLETED:
01:00 PM
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On February 21st, 2023 at approximately 10:15am, Licensing Program Analyst (LPAs), Leslit Tapia-Mandujano and Olguin-Leon conducted a scheduled Pre-Licensing inspection this day and met with Applicant, Marisol Padilla. Applicant has applied for a Large Family Child Care License. Present in the home is applicant. LPAs and applicant inspected entire home for Health and Safety Hazards. Facility has Fire clearance approved by Menlo Park Fire Department on February 16th, 2023.

Applicant rents a home which is a two bedroom, two bathroom single level house with in law unit and backyard with a pool. Applicant lives with three minor children. The hours of operation are Monday-Friday 8am-5:30pm. DAY CARE AREA: In Law unit: Living Room, Bedroom #2, bathroom, outside patio, and grass area in the backyard. OFF LIMITS AREA: Entire Front house, garage, driveway, and pool area in the backyard. All off limit areas are properly barricaded. LPA inspected applicant’s home for health and safety hazards.

LPA observed the following: Day-care is clean, orderly with a variety of age appropriate toys for the children. All furniture inspected is in good repair. The applicant has a fully stocked First Aid kit and thermometer. The home has a pool that is properly barricaded with a fence at least 5 feet high and a door that automatically closes. Per applicant, there is pet cats in the home with proper documentation. Home has a fireplace in the main house. Per applicant, there are no guns or weapons in the home. The home has age appropriate equipment available for children in care. Applicant was reminded baby walkers, bouncers, jumpers and any other similar items are to not be used for children in care. Discipline policy was discussed. Isolation area for sick child will be in in law unit in the room.

The home has sufficient lighting and ventilation. Applicant states they will conduct an emergency drill once every six months and log drills. Applicant's CPR & First Aid expire on 10/2023, Mandated Reporter Training Certificate for applicant expire on 05/2024.

Applicant was 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: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE: DATE: 02/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/21/2023
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: PADILLA, MARISOL
FACILITY NUMBER: 414004987
VISIT DATE: 02/21/2023
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LPA discussed the safe sleep regulations with applicant 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. 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.

APPLICANT WILL WAIT UNTIL FACILITY OPENS TO DETERMINE IMS NEEDS:
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: http://www.ada.gov/childqanda.htm

LPA reviewed with applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant.

During the inspection, LPAs received the following documents: LIC 279B, LIC 610A, LIC 9149, Certificate of Completion of Preventative Health Practices, Certificate of completion of CPR & First Aid, Copy of Lease Agreement with applicant's name, Immunization record with MMR, TDAP, Flu, and LIC 9182 for two adults.

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 information communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

The following items must be completed prior to issuing regular license:
*Results of TB clearance for applicant
*Copy of orientation certificate

A provisional license will be granted effective today, February 21st, 2023. This provisional license will expire in 90 days (May 22, 2023). Prior to issuing regular license all plan of corrections above must be completed.

Exit interview conducted and report was reviewed with the applicant, Marisol Padilla.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2023
LIC809 (FAS) - (06/04)
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