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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004693
Report Date: 05/23/2024
Date Signed: 06/07/2024 05:04:51 PM

Document Has Been Signed on 06/07/2024 05:04 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:PAYNE, LINDAFACILITY NUMBER:
384004693
ADMINISTRATOR/
DIRECTOR:		PAYNE, LINDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 953-9166
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94116
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 7DATE:
05/23/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:45 PM
MET WITH:Linda PayneTIME VISIT/
INSPECTION COMPLETED:
05:30 PM
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On May 23, 2024, Licensing Program Analysts (LPAs) Basak and Van met with licensee Linda Payne to conduct the annual inspection, and the purpose of visit was explained the licensee. LPAs observed present 7 children, licensee and 2 helpers. The licensee rents this single-family home consisting of three bedrooms and two and a half bathrooms. The licensee operate the childcare home from 8:00 am – 5:00 pm Monday- Friday.
LPAs and the licensee inspected the entire home for Health and Safety Hazards. Childcare areas are bedroom #1/toddler room, bedroom #2/infant room, dining room/activities room, and the bathroom in the toddler room and the back yard. OFF-limit areas are the living room, kitchen, patio/sunroom, bathroom, and 1/2 bath on the second level; the entire ground floor, including the licensee's bedroom and garage. All off-limit areas, including closets, are adequately barricaded. Per licensee, all toxic or dangerous chemicals are stored in an off-limit area, making them inaccessible to children.
LPAs observed several baby cribs inside the infant napping room. LPAs advised the licensee that cribs should have no toys or pillows inside and no objects hanging above the cribs. All mattresses shall be designed for that cribs, and bedsheets should be tight-fitted. In addition, the licensee was advised to check on the infant every 15 minutes during naptime physically, and documentation shall be maintained in the infant's file and be available to the Department for review.
LPAs observed the licensee has a pet dog and according to licensee dog is vaccinated and stays in the off-limit area.
Per licensee, there are no firearms or weapons in the home. The isolation area for sick/ill children will be in the hallway area by the main entrance. The house has multiple smoke alarms & carbon monoxide combination detectors. The daycare has sufficient age-appropriate toys, furniture, and napping equipment. The children's bathroom is clean and sanitation. The licensee plans to provide the children breakfast, lunch, and afternoon snacks. The licensee was informed that NO baby walkers, exer-saucers, jumpers, bouncers, and similar items for children in care should be made inaccessible. LPA also reminded the licensee that smoking is prohibited at the daycare.
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SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Zeynep Basak
LICENSING EVALUATOR SIGNATURE: DATE: 05/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/23/2024
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: PAYNE, LINDA
FACILITY NUMBER: 384004693
VISIT DATE: 05/23/2024
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LPAs observed all required postings are posted in the childcare home. The licensee stated that they conduct an emergency drill once every six months and the lates drill was in March 2024.
LPAs discussed the safe sleep regulations with the licensee 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. LPAs also informed the 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.
The licensee 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.
This facility plans to provide Incidental Medical Services – IMS. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm
The licensee was informed about the Provider Information Notices (PINs) on the CCLD website and the sign-up process. The licensee 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. The licensee was informed 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.
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SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Zeynep Basak
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2024
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: PAYNE, LINDA
FACILITY NUMBER: 384004693
VISIT DATE: 05/23/2024
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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 tools, please send them by email 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/process.

During the exit interview, the LICENSEE, LINDA PAYNE, confirmed that there are no Registered Sex Offenders living in the facility, and LPAs completed the RSO profile in FAS.

A notice of site visit was given and must remain posted for 30 days.

An exit interview was conducted, and the report and appeal rights were reviewed with the licensee, Linda Payne.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Zeynep Basak
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2024
LIC809 (FAS) - (06/04)
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