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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004499
Report Date: 01/30/2024
Date Signed: 01/30/2024 03:44:42 PM

Document Has Been Signed on 01/30/2024 03:44 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:VILLENA, MARIEFACILITY NUMBER:
414004499
ADMINISTRATOR:VILLENA, MARIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 822-8522
CITY:SAN MATEOSTATE: CAZIP CODE:
94403
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
01/30/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Licensee, Marie VillenaTIME COMPLETED:
04:00 PM
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On 1/30/2024, at approximately 1:30PM, Licensing Program Analyst (LPA) Jonathan Tse conducted an unannounced annual inspection at the facility. LPA was granted entry to the facility by Licensee, Marie Villena. LPA explained the purpose of the visit. Present during the visit was Licensee, Licensee’s daughter (H2), four infants and three preschool age children. The facility is in compliance with capacity requirements on this day. All adults working or living in the home have acquired fingerprint clearance and are associated to the facility.

Daycare Areas: Living Room, Family Room, Bathroom #1, Bedroom #1 (Baby Room), Master Bedroom (Napping Room), and Backyard.
Off-limits Areas: Kitchen, Dining Room, Bedroom #2, Bathroom #2 (located in Master Bedroom), Laundry Room, Garage, and Shed (located in Backyard).

LPA inspected the home for any health and safety hazards. LPA observed the home to be in clean and orderly condition. LPA observed a smoke and carbon monoxide detector, in addition to a fully charged fire extinguisher. Electrical outlets are covered or inaccessible to children in care. LPA observed age-appropriate toys and learning materials in the Family Room. All cleaning supplies, poisons, and other chemicals are stored inaccessible to children in care. Licensee has mats and cribs for children to sleep on. Sheets and blankets are provided and washed once a week. The facility has a functioning phone line. Per Licensee, there are no weapons or firearms in the home.

LPA observed the Backyard to be free of debris and other loose articles. The Backyard is enclosed by a fence that is at least five feet high. There are age-appropriate toys and equipment for children in care. There are no pools or other bodies of water located in the facility.



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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE: DATE: 01/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/30/2024
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 5
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: VILLENA, MARIE
FACILITY NUMBER: 414004499
VISIT DATE: 01/30/2024
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LPA reviewed eight children’s files and three personnel files. LPA observed all children’s files to be complete. Infant sleep logs are stored digitally and were made available for review. LPA discussed Mandated Reporter Training requirements with Licensee and provided information regarding the training during the visit. Licensee’s First Aid/CPR training is current and expires 10/2024.

All required postings are accessible and available for review in the Family Room. Postings included the facility license, Emergency Disaster Plan (LIC610A) and Notification of Parents’ Rights (PUB394). Licensee provides breakfast, lunch, and afternoon snack for children in care.

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.

Licensee 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 Licensee 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: 01/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: VILLENA, MARIE
FACILITY NUMBER: 414004499
VISIT DATE: 01/30/2024
NARRATIVE
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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/.

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

No deficiencies were cited during today’s visit.
See LIC9102-TV for Technical Violations issued today regarding Mandated Reporter Training.
See LIC9102-TA for Technical Assistance given regarding emergency drill logs.

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

Exit interview conducted and report was reviewed with the licensee, Marie Villena.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024
LIC809 (FAS) - (06/04)
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