414005100-7-2-2024-05-CC-MZAA-D6SVKN-20240702163036

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414005100
Report Date: 07/02/2024
Date Signed: 07/02/2024 04:30:42 PM

Document Has Been Signed on 07/02/2024 04:30 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:	MONTECINOS, NORMA		FACILITY NUMBER:	414005100
ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	07/02/2024
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:00 PM
MET WITH:	Applicant, Norma Sarai Montecinos Aguilar		TIME VISIT/ INSPECTION COMPLETED:	04:55 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 2, 2024 at approximately 2:00pm, Licensing Program Analyst (LPA) Melissa Zaragoza conducted a scheduled, pre-licensing inspection. LPA met with applicant, Norma Sarai Montecinos Aguilar, and explained the purpose of the inspection. Present during LPA's visit included applicant’s spouse. Applicant submitted an application for a family childcare home on April 15, 2024. Applicant lives in a one-level home with their spouse. Applicant plans to operate Monday through Friday 8:00am to 5:00pm. Applicant plans to care for children ages preschool to school age. Applicant is aware anyone 18 and over needs fingerprint background check. With applicant, LPA inspected the entire home, inside and outside, for health and safety hazards. The home is a one-level home that consists of 3 bedrooms, 2 bathrooms, living room, dining area, kitchen, garage, and backyard. The DAY CARE AREAS are the living room, dining room, bathroom #1, bedroom #1, garage for walk through to backyard, and backyard. The OFF LIMIT AREAS are bedroom #2, bedroom #3, bathroom #2, and garage. Off limit areas are made inaccessible with child proof safety gates and child safety locks. LPA observed the day care area to be clean and safe. Home is equipped with a fully charged fire extinguisher that was observed to be secured to wall. Home is equipped with a smoke and carbon monoxide detector. During visit, LPA tested a smoke and carbon monoxide detector that was observed to be working. Day care areas were observed to be equipped with a variety of toys, materials and furniture that were age appropriate. Day care area had many project supplies for children to conduct projects. LPA observed electrical outlets to be made inaccessible with safety covers. (Continue Report on Page 2...)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2024

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: MONTECINOS, NORMA	FACILITY NUMBER: 414005100
	VISIT DATE: 07/02/2024

NARRATIVE

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Kitchen was observed to be clean and safe. Cabinets and drawers were also observed to have child safety locks installed. Knives and sharp objects are made inaccessible with child locks. Bathroom was observed to be in proper working condition. Bathroom is equipped with age-appropriate toileting equipment and sanitation products.

The backyard area is entirely enclosed and fenced. LPA observed backyard to have toys and equipment that were age appropriate. Backyard has cement and fake grass flooring. Backyard had a tent for shade that children can use. 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 to have an area where children can take a break and used redirection to communicate with the children. The designated isolation area will be the dining room. Applicant plans to not provide a food service. Applicant will inform parents; they are to bring a lunch box from home that is labeled with the child name and includes an ice pack. Per applicant, children will be bring a lunch and two snacks from home. Food preparation, sanitization, and children's allergies were discussed.

Applicant's CPR/First Aid training is current and will expire 05/13/2025. Applicant's Mandated Reporter training certification is also current and will expire 09/05/2024. 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 (MMR, Tdap and Flu) that were provided to LPA. Per applicant, there are no weapons or firearms in the home.

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SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2024

LIC809 (FAS) - (06/04)

Page: 2 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: MONTECINOS, NORMA	FACILITY NUMBER: 414005100
	VISIT DATE: 07/02/2024

NARRATIVE

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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 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).

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, 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, 04/15/2024, 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.

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SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2024

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: MONTECINOS, NORMA	FACILITY NUMBER: 414005100
	VISIT DATE: 07/02/2024

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

Exit interview conducted and report was reviewed with the applicants, Norma Sarai Montecinos Aguilar.

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.

As of today’s date 07/02/2024 Applicant will be approved for licensing a Family Child Care Home.

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2024

LIC809 (FAS) - (06/04)

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