384001849-5-10-2023-05-CC-LGOZ-CRPVEP-20230510162239

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384001849
Report Date: 05/10/2023
Date Signed: 05/10/2023 04:23:06 PM

Document Has Been Signed on 05/10/2023 04:23 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	SANTIAGO, JEROME & MARTHA		FACILITY NUMBER:	384001849
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 1	DATE:	05/10/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:20 PM
MET WITH:	Martha Santiago		TIME COMPLETED:	04:35 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 5/10/2023 at 2:20PM., Licensing Program Analysts (LPA), Luis J. Gomez met with Licensee, Martha Santiago. Purpose of the inspection was explained and was for an Unannounced; Annual Random inspection. Present in facility was the licensee caring for 1 child. Children present is infant age. Per licensee, her daughter (Adult) is visiting in the off-limit area. Licensee’s home is a three bedroom, one bathroom, one level unit. Day and hours of operation are Monday- Friday: 7:30AM- 5:30PM. Day-care areas are: Living Room, Bedroom #3 (Playroom), Bedroom #2 (Napping only), Bedroom #1, Bathroom #1 and Kitchen. Off Limit areas are: Laundry Area and Backyard. LPA inspected facility with licensee for health and safety hazards. At 2:25PM., the following was observed: Facility was clean, orderly, with age-appropriate playthings available for the children. Ground surfaces were clear of obstructions or potential hazards. Furniture, toys and books inspected were in good repair. Playroom has child sized table and chairs for seated activities. Per licensee, food services are provided in kitchen. LPA reminded licensee baby walks/ bouncers are not allowed in family childcare home. Licensee removed walker during inspection. Advisory Note: Technical Violation (LIC9102TV) was issued. For napping services, LPA observed an infant play pen (with tight-fitting sheet) available in bedroom #2. Per licensee, napping supplies including sheets are washed weekly. LPA reminded licensee to ensure napping room door remains ajar. Off-limit areas have been made inaccessible to children. Bathroom #1 was maintained clean, with adequate supplies for hand washing. Fixture were in operating condition. Facility had sufficient ventilation and lighting. Home had functioning telephone service; smoke/ carbon monoxide combination detector; and fire extinguisher, 2A:10BC. Home does not have any pools, fishponds, jacuzzi, or bodies of water. (REFER TO 809C, FOR CONT)

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023

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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Document Has Been Signed on 05/10/2023 04:23 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SANTIAGO, JEROME & MARTHA	FACILITY NUMBER: 384001849
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/10/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	At 3:15PM., Based on record review and interview, LPA confirmed licensee has not complete the required ‘Mandated Reporter Certification’, (AB1207). This poses a potential health and safety risk to children in care.
	POC Due Date: 05/24/2023
	Plan of Correction
1 2 3 4	Licensee will complete required mandated reporter training certification (AB1207) by the due date: 5/24/2023. Proof of correction will be submitted to the department via email.

Type B

Section Cited

CCR

102416(c)

Personnel Requirements

(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	At 2:55PM., Based on record review and interviews, LPA confirmed licensee's CPR/1st aid certification has expired. This poses a potential health and safety risk to children in care.
	POC Due Date: 05/31/2023
	Plan of Correction
1 2 3 4	Licensee will enroll and complete CPR/1st aid training course by the due date: 5/31/2023. Proof of correction will be submitted to the department via email.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 05/10/2023 04:23 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SANTIAGO, JEROME & MARTHA	FACILITY NUMBER: 384001849
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/10/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(j)(2)(D)

Infant Safe Sleep

Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	At 3:10PM., Based on record review, LPA confirmed licensee is not documenting infant napping conditions every 15 minutes. This poses a potential health and safety risk to children in care.
	POC Due Date: 05/17/2023
	Plan of Correction
1 2 3 4	Licensee will begin to document infant napping conditon every 15 minutes by the due date: 5/17/2023. Proof of correction will be submitted to the department via email.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023

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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SANTIAGO, JEROME & MARTHA	FACILITY NUMBER: 384001849
	VISIT DATE: 05/10/2023

NARRATIVE

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At 2:45PM, LPA reviewed facility and children’s records. Children’s files were reviewed and included the: Identification of Emergency Information (LIC700); Immunization Record; and Consent for Medical Treatment (LIC627).

At 2:55PM., Based on record review and interviews, LPA confirmed licensee's CPR/1st aid certification has expired.

At 3:10PM., Based on record review, LPA confirmed licensee is not documenting infant napping conditions every 15 minutes.
At 3:15PM., Based on record review and interview, LPA confirmed licensee has not complete the required ‘Mandated Reporter Certification’, (AB1207).

LPA reminded licensee to ensure drills are conducted every six months. Advisory Note: Technical Violation (LIC9102TV) was issued.

Required posting are posted including the: Childcare License. LPA advised licensee to post required Notification of Parent’s Rights Form.

Per licensee, isolation of ill children is in playroom.

LPA advised licensee to ensure all children’s meal containers brought by families must be labeled. Per licensee, home does not have any firearms.

Licensee was reminded all adults, 18 years and over, living or working in the home, including employee and volunteers, must obtain criminal 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.

(REFER TO 809C, FOR CONT.)

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023

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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SANTIAGO, JEROME & MARTHA	FACILITY NUMBER: 384001849
	VISIT DATE: 05/10/2023

NARRATIVE

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(Page 3)
LPA discussed the safe sleep regulations with licensee and discussed Child Care Licensing Safe Sleep Web page at:https://www.cdss.ca.gov/inforesource/child-care-licesning/public-information-and-resources/safe-sleep as an additional resource. LPA informed licensee of the importance of checking for recalled infant devices on United States consumer Product Safety Commission (CPSC) website at http://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tool, please send them to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesource/community-care-licensing/inspection-process.

Based on today's inspection, deficiencies were observed in areas evaluated according to California Title 22, Div. 12 Chap. 3 Health and Safety Code of Regulations and cited on 809D. In exit interview, appeal rights, evaluation report was discussed with Licensee, Martha Santiago, and signature of this form acknowledges receipt of these documents.

LPA unable to print report. Copy of inspection report will be sent to licensee via email.

Notice of Site Visit was provided and must remain posted for 30 days.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023

LIC809 (FAS) - (06/04)

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