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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414005089
Report Date: 04/05/2024
Date Signed: 04/05/2024 03:03:13 PM

Document Has Been Signed on 04/05/2024 03:03 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:TEJADA DE GUTIERREZ, LILIANFACILITY NUMBER:
414005089
ADMINISTRATOR/
DIRECTOR:
FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
04/05/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:LIlian Tejada de GutierrezTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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On April 5, 2024 at approximately 1:30pm, Licensing Program Analysts (LPAs) Catrina Quimbo and Melissa Zaragoza conducted a scheduled, pre-licensing inspection. LPAs met with applicant, Lilian Tejada de Gutierrez, and explained the purpose of the visit. Present in the home were applicants spouse and minor child.

Applicant submitted a family child care home application March 11, 2024. Applicant lives in the multi-level home with their spouse and minor child. Applicant and spouse have fingerprint clearance on file. LPAs reminded applicants children living in the home under 10 years old count towards overall capacity.

Applicant plans to operate Monday to Friday from 7am to 6pm. Applicant plans to care for children ages 6 months to 5 years old. With applicant, LPAs inspected the entire home, inside and outside, for health and safety hazards.

The home is a multi-level home that consists of 3 bedrooms, 2 bathrooms, living room, kitchen, garage, additional unit in garage, and backyard. The DAY CARE AREAS are living room, kitchen, bathroom #1 (next to kitchen). The OFF LIMIT AREAS are all bedrooms and entire ground floor. Off limit areas are made inaccessible with child safety locks and/or a child safety gate. Applicant was notified any off limit areas are not to be used as a day care area without prior approval from the department.

LPAs observed the day care areas to be clean and safe. Home is equipped with a fully charged fire extinguisher and fully stocked first aid kit. There are multiple dual smoke/carbon monoxide detectors in bedrooms and hallway that was observed to be working. LPAs did not observe any accessible chemicals or poisons in day care areas.

There is a fireplace in the living room that is made inaccessible. Applicant plans to install additional padding on fireplace for additional safety. LPAs observed day care areas to be equipped with a variety of age appropriate toys, materials and furniture that was in good working condition. LPAs observed electrical outlets in day care areas to be made inaccessible with child safety covers.

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SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE: DATE: 04/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/05/2024
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: TEJADA DE GUTIERREZ, LILIAN
FACILITY NUMBER: 414005089
VISIT DATE: 04/05/2024
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Bathroom for children’s use was observed to be in proper working condition. LPAs observed poisons, chemicals and other hazardous materials behind child safety locked cabinets in bathroom. Bathroom was properly equipped with age appropriate toileting equipment.

The outdoor area is made off limits. Backyard was observed to be fully fenced and enclosed with an at least 5 ft. high fence. LPAs did not observe any pools, spas or bodies of water on site. Per applicant, backyard area will be added as a day care area eventually. LPAs reminded applicant department must approve of backyard prior to its use.

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 social/emotional visual cues with books and communication. The designated isolation area will be the kitchen, 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, lunch, dinner, and snack. Food preparation, sanitization, children's allergies 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 12/2025. LPA reminded applicant CPR/First Aid training and Mandated Reporter training must be renewed every two years. Applicant was also reminded Mandated Reporter training must be renewed every two years by all staff working with children. Applicant has proof of required immunizations that were provided to department. Per applicant, there are no weapons or firearms in the home. Applicant provided proof of control of property.

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.

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.
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SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2024
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: TEJADA DE GUTIERREZ, LILIAN
FACILITY NUMBER: 414005089
VISIT DATE: 04/05/2024
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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-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, 03/12/2024, 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.

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.

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.

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.

LPAs will recommend for licensure effective todays date, 4/5/2024.

Exit interview conducted and report was reviewed with the applicant, Lilian Tejada de Gutierrez.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2024
LIC809 (FAS) - (06/04)
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