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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002826
Report Date: 03/21/2024
Date Signed: 03/21/2024 03:52:19 PM

Document Has Been Signed on 03/21/2024 03:52 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:LISE LEBOEUFFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 640-9608
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94127
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
03/21/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:55 PM
MET WITH:Helper, Marlene FuselloTIME COMPLETED:
04:00 PM
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On 3/21/2024, at approximately 1:55PM, Licensing Program Analyst (LPA) Jonathan Tse conducted an unannounced annual visit at the facility. LPA was granted entry to the facility by Helper, Marlene Fusello (H1). LPA explained the purpose of the visit. Present during the visit was H1 and four preschool age children. Per H1, Licensee Lise Lebeouf was not present due to a personal issue. The facility is in compliance with capacity and ratio requirements on this day. The facility’s current operating hours are from 8:30AM to 4:30PM.

Daycare Areas: Living Room, Kitchen, Bathroom, and Backyard.
Off-limits Areas: Room 2, Room 3, and the entire lower level.

LPA inspected the home for any health or safety hazards. LPA observed the home to be in clean and orderly condition. There are age-appropriate toys and learning materials present in the Living Room. There is a fully charged fire extinguisher present. LPA observed a carbon monoxide detector to be present in the Living Room. There is no fireplace present in the daycare areas. Electrical outlets were observed to be covered or obstructed by furniture to be inaccessible to children in care. Children sleep on cots that are provided by the facility. Bedding and sheets are provided from home and taken back once a week for cleaning. Children are provided with AM/PM snacks in addition to lunch. Per H1, they serve vegetarian meals. Per H1, there are no weapons or firearms in the home.

LPA observed the Kitchen to have cabinets and drawers that contain hazards to children to be locked and secured. Poisons, cleaning detergents, and other chemicals are stored inaccessible to children in care. LPA observed childproof covers on the stove knobs.


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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE: DATE: 03/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/21/2024
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: LEBOEUF, LISE
FACILITY NUMBER: 384002826
VISIT DATE: 03/21/2024
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LPA observed the Backyard to be free of debris and other loose articles. There are age-appropriate toys and play equipment for children in care. LPA observed a swing set and a slide to be present for children in care. The Backyard is enclosed by a fence that is at least five feet high. There are no pools or other bodies of water present in the facility.

LPA reviewed facility records and four children’s files. H1’s First Aid/CPR expires 1/2025. Licensee’s First Aid/CPR and Mandated Reporter Training both expire on 4/2024. LPA advised H1 that their records must be maintained in the facility. See LIC9102-TV for technical violation issued today regarding personnel records. LPA observed all children’s files to be complete. All required postings are posted and accessible for review.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries to [email protected]. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

H1 was reminded that all adults 18 and over living or working in the home, 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.

LPA discussed the safe sleep regulations with H1 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 licensee 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.

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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2024
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: LEBOEUF, LISE
FACILITY NUMBER: 384002826
VISIT DATE: 03/21/2024
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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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the
ADA, available at: https://www.ada.gov/resources/child-care-centers/.

H1 was informed of the MyChildCarePlan.org website; 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.

During the exit interview, H1 confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

See LIC9102-TV for Technical Violations issued today regarding personnel records and operation of a family child care home. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with H1, Marlene Fusello.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2024
LIC809 (FAS) - (06/04)
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