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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414005069
Report Date: 12/29/2023
Date Signed: 12/29/2023 02:06:55 PM

Document Has Been Signed on 12/29/2023 02:06 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:GRAY, TANYAFACILITY NUMBER:
414005069
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
12/29/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Tanya GrayTIME COMPLETED:
02:25 PM
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On December 29, 2023, Licensing Program Analyst (LPA)Maria Olguin-Leon conducted an announced, pre-licensing inspection. LPA met with applicant, Tanya Gray and explained the purpose of the inspection. Applicant submitted a small family childcare application to our department on December 5, 2023. Applicant previously had a dual licensee at facility #414004709, at a different location and applying as sole applicant. Hours of operation will Monday-Friday from 8:00AM to 6:00PM. Applicant plans to provide care to children ages (20 mths. - 6 yrs. old). Applicant lives in home with spouse. Present during today’s visit was applicant, spouse, and friends Elmira Valiullina and spouse. Elmira translated from English to Russian for applicant.

With applicant, LPA inspected the indoors and outdoors of the home for health and safety hazards. Applicant rents this one-story home that consists of a foyer, living room, family room, dining room, kitchen, 5 bedrooms 2 bathrooms, backyard, and garage. The DAY CARE AREAS: are foyer, living room, family room, bedroom #2, bedroom #5 and bathroom and backyard. The OFF-LIMIT AREAS kitchen, bedrooms #1, #3(office), #4 and garage. 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, family room and bedroom #2 are equipped with plenty of age-appropriate toys, learning material, toy storage cubbies, child size furnishing and sleeping beds. Applicant will provide sheets for beds and applicant will wash weekly. Fireplace is properly barricaded. All electrical outlets are properly covered with childproof covers. All cabinets are secured with childproof locks. Kitchen and dining area are properly barricaded with childproof gates. Backyard has a cement patio covered with area rugs and equipped with grass and artificial grass to cushion falls. Backyard is equipped with a swing set, ride on toys, and age-appropriate toys. There is a 5 ft. fence surrounding entire backyard. Sides of home are properly barricaded. No spas, pools or bodies of water were observed.

Cont. page 2...
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE: DATE: 12/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/29/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
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: GRAY, TANYA
FACILITY NUMBER: 414005069
VISIT DATE: 12/29/2023
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Home has proper 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 applicant, there are no weapons or firearms in the home.

Home is equipped with working carbon monoxide detector and working smoke detectors. Home is equipped with a fully charged fire extinguisher. 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 foyer area and away from other children and where applicant can supervise all children in care. For discipline, applicant will talk and redirect children.

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 08/2025. Applicants Mandated Reporter training certificates (AB1207) is current that will expire 08/2025. All required documents are properly posted. LPA provided applicant with LIC126.

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: breakfast, lunch, dinner and two snack to children in care. LPA 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: 12/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2023
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: GRAY, TANYA
FACILITY NUMBER: 414005069
VISIT DATE: 12/29/2023
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The applicant provided proof of control of property. The applicant 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.

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.

On this date, 12/06/2023, 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.


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

DATE: 12/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2023
LIC809 (FAS) - (06/04)
Page: 4 of 4
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: GRAY, TANYA
FACILITY NUMBER: 414005069
VISIT DATE: 12/29/2023
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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 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 recommend licensure for Small Family Child Care License as of today, December 29th, 2023.

Exit interview conducted and report was reviewed with the applicant, Tanya Gray and Elmira Valiullina (translated report).
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 12/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4