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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414005064
Report Date: 11/20/2023
Date Signed: 11/20/2023 11:09:05 AM

Document Has Been Signed on 11/20/2023 11:09 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:MENDOZA CONTRERAS, JENNIFFERFACILITY NUMBER:
414005064
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
11/20/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:54 AM
MET WITH:Jennifer Mendoza ContrerasTIME COMPLETED:
11:11 AM
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On November 20, 2023, Licensing Program Analyst (LPA)Maria Olguin-Leon, conducted an announced, pre-licensing relocation inspection in conjunction with an increase of capacity visit. LPA met with applicant, Jenniffer Mendoza Contreras and explained the purpose of the inspection. Applicant submitted a relocation application to our department on November 3, 2023. Applicant has relocated from Facility #414004772 to this location. Hours of operation will Monday-Friday from 8:00AM to 6:00PM. Applicant plans to provide care to 6 mths. – 12 yrs. old.

With applicant, LPA inspected the indoors and outdoors of the home for health and safety hazards. Applicant rents this single-story home that consists of a living room, dining room, 4 bedrooms 2 bathrooms and garage. Applicant lives in home with three fingerprint cleared adults and 3 minor children. The DAY CARE AREAS are the living room (playroom), dining room, bathroom #1, outdoor deck and backyard. The OFF-LIMIT AREAS are all four bedrooms, kitchen, bathroom located between bedroom #1 and bedroom #2. Applicant was notified any off-limit areas are not to be used as a day care area without prior approval from department.

LPA observed the following: Home was clean and orderly. Living room and dining room area are equipment plenty of age-appropriate toys, toy storage cubbies, bookcase, child size furnishing and sleeping cots. Applicant will provide sheets for cribs/playpens and applicant will wash weekly. There are two fireplaces properly barricaded, and edging covered with rubber stripping. All electrical outlets are properly covered with childproof cover and bookcase properly secured to wall. Deck area is equipped with a childproof gate to separate from backyard. Backyard is equipped with a grass area, cement patio and flat rock embedded into dirt. There is a 5 ft. fence surrounding entire backyard. No spas, pools or bodies of water were observed.

Home has ventilation and lighting throughout. Per applicant, off-limit areas will remain locked during operating hours with child proof latches or closed doors. All detergents, cleaning compounds, medications and other items which could pose a danger are stored inaccessible to children behind child safety locked cabinets and/or located in off limit areas. Per applicants, there are no weapons or firearms in the home. Applicant carried liability insurance with Accord ex 10/2024.

Cont. page 2...
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE: DATE: 11/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/20/2023
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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: MENDOZA CONTRERAS, JENNIFFER
FACILITY NUMBER: 414005064
VISIT DATE: 11/20/2023
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Home is equipped with a working smoke and carbon monoxide detectors. LPA observed a first aid kit fully stocked with necessary supplies. Applicant uses a designated cell phone and is aware the cell phone must stay within the home during the day care hours. Isolation area for sick children will be in dining area and away from other children and where applicant can supervise all children in care. Applicant will use calming techniques and talking to children for discipline techniques.

LPA reviewed the LIC311D, Records to Keep in Your Family Child Care Home, children’s forms/ records, facility forms, and information to be posted. Entrance Checklist was provided to the applicant. Applicant’s CPR/First Aid certification is current and will expire 01/2025. Applicants Mandated Reporter training certificates (AB1207) is current that will expire 03/2025.

LPA and applicant 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 plans to provide meals: snack, breakfast, and lunch. LPAs discussed sanitation and allergies with applicants. LPA reminded Applicant to label all food brought from home.

Applicant understands the required emergency disaster drills are to be conducted and documented at least once every six months. Applicant understands 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 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.



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

DATE: 11/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2023
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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: MENDOZA CONTRERAS, JENNIFFER
FACILITY NUMBER: 414005064
VISIT DATE: 11/20/2023
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The applicant provided proof of control of property. 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).

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 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 [applicant, licensee, or facility representative] 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.

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

DATE: 11/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2023
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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: MENDOZA CONTRERAS, JENNIFFER
FACILITY NUMBER: 414005064
VISIT DATE: 11/20/2023
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On this date, 11/07/2023, 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.

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 at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication

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

LPA will approve relocation license as of today, 11/20/2023.

Exit interview conducted and report was reviewed with the applicant, Jenniffer Mendoza Contreras.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2023
LIC809 (FAS) - (06/04)
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