414005025-7-20-2023-05-CC-CQUO-CTWPVA-20230720113851

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414005025
Report Date: 07/20/2023
Date Signed: 07/20/2023 11:38:57 AM

Document Has Been Signed on 07/20/2023 11:38 AM - 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:	MERIDA, HEALY A.		FACILITY NUMBER:	414005025
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	07/20/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Healyn Merida		TIME COMPLETED:	12:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On July 20, 2023 at approximately 8:30am, Licensing Program Analyst (LPA) Catrina Quimbo conducted a scheduled pre-licensing inspection. LPA met with applicant, Healyn Merida, and explained the purpose of the inspection. Present during LPA's visit included applicant and applicant's minor children. Applicant submitted a family child care home application June 16, 2023. Applicant lives in the home with their two minor children. Applicant was reminded children under 10 years old whom live in the home, are counted towards facility's overall capacity. Applicant plans to operate Monday through Friday 8:00am to 5:30pm. Applicant plans to care for children ages 6 months to 5 years old. With applicant, LPA inspected the entire home for health and safety hazards. The home is a single level home that consists of 3 bedrooms, 2 bathrooms, living room, dining area, kitchen, backyard and garage. The DAY CARE AREAS are the living room, dining area, hallway bathroom, bedroom #2 (napping room next to hallway bathroom), and half of backyard. The OFF LIMIT AREAS are bedroom #1, master bedroom with bathroom, garage, and half of backyard. Off limit areas are made inaccessible with child safety gates and/or child proof door handles. Applicant was notified any off limit areas are not to be used as a day care area without prior approval from the department. LPA observed the entire home to be clean and safe. Home is equipped with a fully charged fire extinguisher and a fully stocked first aid kit. There is a dual smoke/carbon monoxide detector near living room that was observed to be working. LPA observed living room and dining area to be equipped with a variety of age appropriate toys, materials and furniture that was in good working condition. LPA observed electrical outlets in day care areas to be made inaccessible with child safety locks. The nap room is equipped with cots and cribs that were observed to be new and in good working condition. Bathroom for children's use was observed to be in working condition, equipped with appropriate toileting and sanitation materials. Poisons, chemicals and hazardous materials are made inaccessible behind child safety locked cabinets and/or located in off limit areas. Garbage can was observed to have a tight fitting lid. (Continue on Page 2...)

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023

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: MERIDA, HEALY A.	FACILITY NUMBER: 414005025
	VISIT DATE: 07/20/2023

NARRATIVE

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The entire backyard is enclosed with an at least 5 ft. high fence. Half portion of backyard (outside of dining area) is a day care area while other half portion of backyard (outside of off limit master bedroom) will be an off limit area. Applicant plans to make off limit area of backyard inaccessible to children. LPA did not observe any pools, spas or bodies of water on site.

Applicant was reminded baby walkers, bouncers, jumpers and any other similar items are not to be used for children in care. LPA reminded applicant emergency disaster drills are to be conducted and documented at least once every six months.

Applicant's discipline policy will be through communicating and redirecting children. The designated isolation area will be in the nap room, separate from other children in care. LPA reminded applicant children must be supervised at all times. Applicant plans to provide a food service that includes breakfast and snack only. Food preparation, storage and sanitization was discussed.

Applicant's CPR/First Aid training is current and will expire 06/2025. Applicant's Mandated Reporter training certification is also current and will expire 06/2025. LPA reminded applicant CPR/First Aid training must be renewed every two years. Applicant was also reminded Mandated Reporter training must be renewed every two years by applicant and all staff hired by applicant. Applicant has proof of required immunizations on file.

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, 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.

Because the applicant rents/leases the home, proof of landlord notification is
required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).
(Continue Report on Page 3...)

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023

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: MERIDA, HEALY A.	FACILITY NUMBER: 414005025
	VISIT DATE: 07/20/2023

NARRATIVE

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This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. 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) or (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.

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-andresources/safe-sleep, as an additional resource. LPA also informed applicant 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.

On this date, 06/16/2023, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Applicant was informed of the MyChildCarePlan.org site, 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.
(Continue Report on Page 4...)

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023

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: MERIDA, HEALY A.	FACILITY NUMBER: 414005025
	VISIT DATE: 07/20/2023

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

During visit, LPA obtained from applicant completed Pre-licensing Readiness Guide (LIC9217) and updated Emergency Disaster Plan (LIC610A).

Prior to recommended licensure, following must be completed:
-Posting of required licensing documentation.
-Proof of 8 hour Preventive Health certification (EMSA) certified for applicant.
-Inaccessibility of fireplace in living room.
-Inaccessibility of off limit back yard area.
-Fingerprint clearance for applicant.

Exit interview conducted and report was reviewed with the applicant, Healyn Merida.

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023

LIC809 (FAS) - (06/04)

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