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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414005172
Report Date: 12/06/2024
Date Signed: 12/06/2024 12:32:00 PM

Document Has Been Signed on 12/06/2024 12:32 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:JAN, SAVANNAH M.FACILITY NUMBER:
414005172
ADMINISTRATOR/
DIRECTOR:
FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
12/06/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Savannah M.JanTIME VISIT/
INSPECTION COMPLETED:
01:05 PM
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On December 6th 2024, at approximately 11:00 AM., Licensing Program Analyst (LPA) Janet Gil conducted an announced pre-licensing inspection and met with the Applicant, Savannah M.Jan. LPA was granted entry by the applicant. This is a change of location from 1856 El Parque Unit B, San Mateo, CA. 414004892. LPA explained the purpose of the visit to the applicant.

The applicant living in the home has a cleared background check and can be present in the childcare facility. Applicant rents this unit consisting of a living room, dining room, 2 bedrooms(one master bedroom), 2 bathrooms, and a kitchen. Days and hours of operation will be Monday through Friday, 8:30 AM to 5:30 PM, with the option of after hours if needed.

Day Care Areas: Living room, Dining Room, Children's Bathroom, Bedroom/Nap Room, and Front Yard. Per applicant, she plans to utilize the dining room as an isolation for sick/ill children.

Off-limit Areas: Master Bedroom, Master Bathroom, and Kitchen

At approximately 11:30 AM, LPA and the applicant inspected the entire home for Health and Safety Hazards. The home is clean and orderly and has sufficient lighting and ventilation. LPA observed an open face heater in living room area that was not properly barricaded and made inaccessible to children. LPA reminded licensee that all open face heaters must be inaccessible to children in care. There are a variety of age-appropriate toys and books for children. LPA observed 8 playpens and 1 sleeping mat in Bedroom/Nap Room. Applicant plans to purchase more sleeping mats if needed. Applicant plans to have parents wash any sheets or blankets weekly. All furniture and playthings were observed to be in repair. The facility has a carbon monoxide detector in the home. LPA tested detector in dining room which was observed to be in working condition. LPA observed a fully charged fire extinguisher 2A10 BC by front door of home. All harmful objects, sharp objects, and toxins are stored inaccessible to children in kitchen area with a child safety lock and child safety gate around kitchen area.

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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Janet Gil
LICENSING EVALUATOR SIGNATURE: DATE: 12/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/06/2024
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: JAN, SAVANNAH M.
FACILITY NUMBER: 414005172
VISIT DATE: 12/06/2024
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Applicant states that the home has no weapons, firearms. All Electrical outlets have been covered by outlet covers in all Child Care areas of the home. The facility has no bodies of water, such as a swimming pool, spa, hot tub, or fishpond. Facility has front yard outdoor play space that is enclosed with sufficient toys for children.

At approximately 12:15 PM, LPA informed the applicant that emergency drills are required every six months and must be documented. Applicant was reminded that NO baby walkers, exer-saucers, jumpers, bouncers, and any similar items to be used for children in care should be made inaccessible. In addition, booster chairs are only used for the purpose of feeding/eating. Per applicant, all food will be provided by parents or authorized representatives. The applicant was also reminded that smoking is prohibited at the Day Care.

Per applicant, she plans to provide care to children of infant age and preschoolers. Per applicant, she plans to purchase liability insurance for childcare. LPA informed applicant that if childcare insurance is not purchased, each parent must be given the Affidavit Regarding Liability Insurance for Family Child Care Home (LIC 282). Applicant’s Pediatric First Aid CPR is expired and she has a scheduled training on 12/15/2024 and Mandated Reporter Training expires on 10/29/2026. The Mandated Reporter certificate is valid, and a copy has been submitted to the Department. Applicant was reminded that both certificates expire in two years.

LPA reviewed with the Applicant the LIC 311D; Forms/Records to Keep In Your Family Child Care Homes, children's forms/records, facility forms/records, and all required postings such as License/Parent's Rights poster/Emergency Disaster Plan and Earthquake Preparedness checklist. In addition, the Entrance Checklist was also provided to the applicant. The applicant plans to have all the required posting on the wall next to her front door up the stair case. Per applicant, she is already aware of all required forms since she has been licensed for years prior to relocating.

License capacity regulations were also reviewed with applicant. LPA informed the applicant that a large license with a capacity of 12 to 14 children require an assistant to be present.

Applicant 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.

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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Janet Gil
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2024
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: JAN, SAVANNAH M.
FACILITY NUMBER: 414005172
VISIT DATE: 12/06/2024
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Because the licensee 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).



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 discussed the safe sleep regulations with the applicant and discussed the Child Care Licensing Safe Sleep webpage https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/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, 12/5/2024, 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.

Applicant was reminded that as of September 1, 2016, a person may not be employed or volunteer at a childcare facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662. The Applicant was encouraged to obtain a copy of regulations and current licensing forms through the Department's website at www.ccld.ca.gov. The Applicant was also reminded of Mandated Reporter Online Training for Child Care Providers (AB 1207) and the additional General Training, and both are available on www.mandatedreporteca.com.

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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Janet Gil
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2024
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: JAN, SAVANNAH M.
FACILITY NUMBER: 414005172
VISIT DATE: 12/06/2024
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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.

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 platform.

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.


Capacity limits of a Large Family Child Care License has been reviewed.

Prior to approval of Large Family Childcare: Savannah M.Jan shall complete and submit verification of the following:

- Submit proof of properly barricaded open face heater in Living Room Area

- Obtain Fire Clearance for large license

-CPR Certification

-Proof of Rental Agreement for Unit A

Exit interview conducted and report was reviewed with the applicant Savannah M.Jan. The report was signed by the Applicant, Savannah M.Jan and provided to her as a printed copy. This report will be kept in the facility file and available for public review upon request. Desk duty is available Monday - Friday, 8:00 AM – 5:00 PM (650) 266-8800. Website for Forms and Regulations: www.cdss.ca.gov.

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Janet Gil
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2024
LIC809 (FAS) - (06/04)
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