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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 11:39:55 AM

Document Has Been Signed on 11/20/2023 11:39 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: 0CENSUS: 0DATE:
11/20/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:17 AM
MET WITH:Jenniffer Mendoza ContrerasTIME COMPLETED:
11:05 AM
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On November 20, 2023, Licensing Program Analyst (LPA) Maria Olguin-Leon conducted an announced relocation in conjunction with a capacity increase inspection. LPA met with licensee, Jenniffer Mendoza Contreras, and explained the purpose of the inspection. Present during inspection was licensee.

The licensee relocated to this home and has been approved for a small family childcare home. The licensee applied for a relocation and increase of capacity on November 3, 2023. Licensee has been a licensed daycare provider since 06/18/2021.

Hours of operation are Monday to Friday from 8:00am to 6:00pm. 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. All off limits areas are made inaccessible to children with childproof gates, child safety doorknobs and latches.

LPA observed home to be equipped with a variety of age-appropriate toys and learning materials that are in good condition. Outdoor area is equipped with age-appropriate toys and materials that were also in good working condition. LPA did not observe any pools, spas, or bodies of water on the property. All cleaning supplies, poisons, other chemicals, and sharp objects were stored inaccessible to children on high shelves and/or behind child safety locked cabinets. Per licensee, there are no weapons or firearms in the home.

Home is equipped with a fully charged fire extinguisher, smoke/carbon monoxide detectors and fully stocked first aid kit.

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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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Capacity limits and ratios for a large family day care have been reviewed with licensee on this date. LPA reminded licensee that an assistant must be present when operating as a large license. LPA reminded licensee when an assistant is not present, licensee must operate as a small license.

The licensee's CPR and First Aid training is current and will expire 01/2025. The licensee's Mandated reporter training is also current and will expire 03/2025. Licensee was reminded baby walkers, bouncer, jumpers, and any other similar items are not to be used for children in care.

Licensee was reminded that all adults 18 and over living or working in the home, 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.

During today's visit, no deficiencies were cited.

Prior to approval of large license, the following must be completed:

-Fire inspection Clearance.

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

Exit interview conducted in Spanish and report was reviewed with licensee, 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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