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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004899
Report Date: 06/14/2023
Date Signed: 06/14/2023 05:07:49 PM

Document Has Been Signed on 06/14/2023 05:07 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:ALVES, ALINE C.FACILITY NUMBER:
414004899
ADMINISTRATOR:ALINE C. ALVESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 389-6974
CITY:SAN MATEOSTATE: CAZIP CODE:
94402
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
06/14/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Aline AlvesTIME COMPLETED:
05:10 PM
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On 6/14/2023 at 2:10PM., Licensing Program Analysts (LPA), Luis J. Gomez met with Assistant, Natasha De Silva. Purpose of the inspection was explained and was for an Unannounced; Annual Random inspection; and to add bedroom #1 into the on-limit areas. Licensee, arrived during inspection. Present in facility was the licensee, licensee’s daughter and helper caring for 10 children (3 infant age, 7 preschool age). Adults have criminal record clearances on file. Licensee’s home is a 3 bedroom, 1 bathroom, 2 level house. Days and hours of operations are Monday- Friday, 8:00 A.M., to 5:00 P.M. Day-care Areas are: Lower Level: Playroom, Outdoor Play Area, Bedroom #1 and Upper Level: Bathroom #1 Off-limit Areas are: Lower Level: Gated Laundry Area, Garage and Upper Level: Kitchen, Bedroom #2, Bedroom #3, Living room and Upper Outdoor Patio. LPA inspected home, indoors and outdoors, with licensee for health and safety hazards.

At 2:35PM., the following was observed: Facility was clean, orderly, with age-appropriate playthings available for the children. All floors and ground surfaces were clear of obstructions or potential hazards. Accessible furniture, toys and items inspected were in good repair. Several child sized table and chairs are available for snack and seated activities. For napping services, LPA observed cots and infant playpens stored in the playroom. The off-limit areas of the home have been made inaccessible with child safety gates. Bathroom #1, located upstairs, was maintained clean, with supplies for hand washing. Fixtures were in operating condition. Low-hanging cabinets are equipped with safety hooks. Facility was the proper temperature, with ventilation, and lighting. Home had functioning telephone service, smoke/ carbon monoxide combination detector, and fire extinguisher: 3A40BC.

At 2:50PM., LPA inspected the backyard area. Backyard is completely enclosed and is free of debris or hazardous plants. Soft turf padding has been installed for added safety, and shading is available. Outdoor playthings inspected were in like-new, condition. Safety gate has been installed on the back deck. Facility does not have any pools, fishponds, jacuzzi, or bodies of water. (REFER TO 809C, FOR CONT)
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 06/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/14/2023
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 4
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: ALVES, ALINE C.
FACILITY NUMBER: 414004899
VISIT DATE: 06/14/2023
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(Page 2)
At 3:10PM, LPA reviewed the facility and children’s records. Children’s records were reviewed and included the: Identification of Emergency Information (LIC700); Notification of Parent's Rights (LIC995); Individual Infant Sleeping Plan (LIC9227);Required Immunization Record; and Consent for Medical Treatment (LIC627).

Personnel Records were reviewed and included the: Statement Acknowledging Requirement to Report Suspected Child Abuse (LIC9108); Notice of Employee Right (LIC9052); Proof of Required Immunization; and Mandated Reporter Training Certification (AB1207).

LPA reminded licensee to maintain documentation napping condition every 15 minutes for all infants in care. Advisory Note: Technical Violation (LIC9102TV) was issued.

Licensee’s Cardiopulmonary Resuscitation (CPR)/ First Aid certification was current, expiring: 6/2024.


Licensee’s required 'Mandated Reporter Training' certification (AB1207) was current, expiring: 3/2025.

Licensee’s is conduct, and document emergency disaster drills once every 6 months, with last drill done on: 3/24/2023, properly logged.

Required posting are posted, including Childcare License, Notification of Parent’s Rights (PUB379), Emergency Disaster Plan (LIC610A). Per licensee, isolation of an ill children is in the playroom.

Per licensee, home does not have any firearms or weapons to report.

Bedroom #1, on the lower level, was reviewed during inspection. Area was observed free of hazards or dangerous conditions. Per licensee, bedroom #1 will be used for napping only. LPA reminded licensee to ensure bedroom door remains open while in use. License submitted updated LIC999, Facility Sketch to the Department.

On 6/14/2023, Bedroom #1 was added to the on-limit areas.



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.)
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2023
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: ALVES, ALINE C.
FACILITY NUMBER: 414004899
VISIT DATE: 06/14/2023
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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 [email protected]. 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, no deficiencies were observed in areas evaluated according to California Title 22, Div. 12 Chap. 3 Health and Safety Code of Regulations. In exit interview, evaluation report was discussed with Aline Alves, and licensee’s signature of this form acknowledges receipt of these documents.

Notice of Site Visit was provided and must remain posted for 30 days.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2023
LIC809 (FAS) - (06/04)
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