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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005383
Report Date: 02/14/2023
Date Signed: 02/14/2023 04:15:45 PM

Document Has Been Signed on 02/14/2023 04:15 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
PENINSULA CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:DUQUE, KARINA & GALEANA, VICENTEFACILITY NUMBER:
214005383
ADMINISTRATOR:DUQUE, K. & GALEANA, V.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 686-7328
CITY:SAN RAFAELSTATE: CAZIP CODE:
94901
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 10DATE:
02/14/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Karina DuqueTIME COMPLETED:
04:30 PM
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On 2/14/2023, Licensing Program Analyst (LPA), Hanson Leong, made an unannounced annual visit to the Karina Duque & Vicente Galeana’s day-care facility. The LPA was granted entry by the Licensee, Karina Duque. The LPA explained the purpose of the visit to the licensee. All the individuals listed on the facility’s roster have been granted permission to work or be present in a childcare facility. The LPA observed both licensees supervising two infants and eight preschool children. Children's capacity and ratio requirements were observed to be in compliance. During the visit, there was a dog present in the facility.

Day-care Areas: Living room (main activity room), a bedroom (converted into a playroom downstairs), bathroom in the lower level.

Off-limit Areas: Kitchen, the upstairs bedrooms, garage/workshop downstairs, applicant's bedroom, and the left side alley. All off-limit areas are secured with a locked door or a safety gate. The licensees understands that off-limits areas may not be used for childcare during business hours.

The LPA and the licensee both performed careful inspections of the day-care facilities 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 day-care. The building has sufficient lighting and ventilation, and it is free of any defects or conditions that could put the children in its care in 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 day-care facility is equipped with a smoke detector, a 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 their reach. The LPA did not find any walkers, bouncers, or other comparable objects during its inspection.

There are reportedly no firearms or other weapons on the premises, as stated by the licensees.

The LPA found that the facility did not have any pools, spas, or other types of bodies of water of any kind


***See Page 2 for continuation***
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE: DATE: 02/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/14/2023
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PENINSULA CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: DUQUE, KARINA & GALEANA, VICENTE
FACILITY NUMBER: 214005383
VISIT DATE: 02/14/2023
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Continued, Page 2
The LPA observed that the facility had posted all the required forms, including the facility license, Notification of Parental Rights, Earthquake Preparedness Checklist, and Notification of Personal Rights. The licensee is aware that smoking is not permitted in a family childcare facility.

The LPA reviewed the records of five children. All required forms were in the files of the five children.

The LPA reviewed the records of the two licensees. All required forms were in the files of the two licenses. Review of the training records shows that one of the licensees is current with her Pediatric First Aid / CPR certifications.

The following reminders were discussed with the licensees:


1. All adults 18 and over living or working in a licensed childcare facility, 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 childcare facility.
2. Incidental Medical Services (IMS) policy
3. As of January 1, 2018, all staff must complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. 4. Regulations for safe sleeping in accordance with the Health and Safety Code. 5. Checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/
6. Unpaid annual fees
7. Documenting fire drills
8. Required postings, license, PUB 394, and LIC 9148

No deficiencies were issued today

A copy of this report, and the “Notice of Site Visit” were given to the licensee.

A “Notice of Site Visit” must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

An exit interview was conducted, and the report was reviewed with the Licensee, Karina Duque

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2023
LIC809 (FAS) - (06/04)
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