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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002826
Report Date: 11/02/2023
Date Signed: 11/02/2023 03:46:12 PM

Document Has Been Signed on 11/02/2023 03:46 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:LEBOEUF, LISEFACILITY NUMBER:
384002826
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
11/02/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:19 PM
MET WITH:Leboeuf, LiseTIME COMPLETED:
04:00 PM
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On 11/3/2023, Licensing Program Analyst (LPA) Tso and Mok, made an unannounced case management visit to the Family Child Care Home listed above. The Licensee, Lise Leboeuf, requested a visit from the department to increase capacity from eight (Small License) to fourteen children (Large License). The LPA was granted entry by the licensee. The LPA explained the purpose of the visit to licensee. The LPA observed that there is no child in care during the visit.

The LPAs and the licensee both performed careful inspections of the daycare facility to look for any potential health and safety hazards. Toys and equipment that are suitable for children of the proper age range are provided at the daycare. The building has sufficient lighting and ventilation. LPAs observed that the stoven switches are installed child knobs. LPAs observed that the followings needed to be fixed before recommending an increase capacity approval.

1. The windows in the living room can be opened more than 4”. Need to be locked or restricted opening up to maximum 4” only.

2. There are 2 heaters in the living room and in the bathroom respectively. They should be barricaded that inaccessible to the children.

3. Licensee installs the gate to barricade the stairs entrance going to the lower floor.

4. Licensee removes the glass bottles to the places that inaccessible by children.

5. Licensee installs the childproofed locks to lock the doors of the cabinets in the kitchen.

6. Clean up the toys and tricycles in the backyard before use.

7. Lock up the tools, such as hammer, etc.

8. A plastic bucket filled with water. Reminded the licensee either using a lip to lock or empty it.

Apart from the above, it is free of any defects or conditions that put children at risk. The facility is equipped with a first aid kit that is completely loaded with everything that is required for the treatment of injuries. The daycare facility is equipped with a multi-function of smoke and carbon monoxide detector, and a fire extinguisher that is always ready for use. Every garbage can and power outlet has been covered. Products for cleaning and washing, detergents, and any other materials that could put children in danger are stored out of the children’s reach. The LPA did not find any walkers, bouncers, or other comparable objects during today’s inspection. According to the licensee, there are reportedly no firearms or other weapons on the premises. The LPA found that the facility did not have any pools, spas, or other types of bodies of water of any kind, except the plastic bucket filled water mentioned.above.

The licensee has obtained a signed Property Owner/Landlord Consent form (LIC9149). They can operate with a maximum capacity of 14 children.

The LPA will not recommend Lise Leboeuf for a Large Family Child Care Home License until the facility provides the clearance proof of the above said to the Licensing.



A copy of today’s report and the Notice of Site Visit were given to Lise Leboeuf. An exit interview was conducted, and the report was reviewed with Lise Leboeuf.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Man Tso
LICENSING EVALUATOR SIGNATURE: DATE: 11/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/02/2023
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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