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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005427
Report Date: 02/15/2024
Date Signed: 02/15/2024 03:36:26 PM

Document Has Been Signed on 02/15/2024 03:36 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:CRUZ, LEILA M.FACILITY NUMBER:
214005427
ADMINISTRATOR:CRUZ, LEILA M.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 879-7188
CITY:MILL VALLEYSTATE: CAZIP CODE:
94941
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
02/15/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Licensee, Leila CruzTIME COMPLETED:
03:45 PM
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On 2/15/2023, at approximately 1:15PM, Licensing Program Analyst (LPA) Jonathan Tse conducted an unannounced annual visit at the facility. LPA was granted entry to the facility by Licensee, Leila Cruz. LPA explained the purpose of the visit. Present during the visit was the Licensee, three helpers, four infants, and four preschool age children. The facility is operating within capacity requirements on this day. The facility’s operating hours are from 8:00AM to 5:30PM, Monday to Friday.

Daycare Areas: Family Room, Bedroom 2, Bedroom 3, Bathroom, Front Yard, and Backyard.
Off-limits Areas: Bedroom 1, Kitchen, and Side Yard.

LPA inspected the home for any health and safety hazards. LPA observed the home to be in clean and orderly condition. The home is equipped with a fully charged 3A40BC fire extinguisher. There is a smoke detector in addition to a fire alarm system in the home. There is a carbon monoxide detector present in the Family Room. LPA observed age-appropriate toys and learning materials to be present in the Family Room and Bedroom 3. Poisons, detergents, and other chemicals are stored inaccessible to children. LPA observed four cribs to be in use for each infant present during the visit. Cribs were observed to be free of toys, blankets, and other loose materials. All off-limits areas are kept inaccessible to children in care.

The Backyard and Front Yard were observed to be free of debris and other loose material. They are enclosed by fences that are at least five feet high. There are age-appropriate toys and equipment present in the yards. There are no pools or other bodies of water located in the facility.

LPA reviewed three personnel files and eight children’s files. LPA observed all children’s files to be complete. LPA discussed Mandated Reporter training requirement with Licensee. All required postings were observed to be posted in the entrance of the facility. The last emergency drill was conducted on 11/22/2023. Emergency drills are properly documented and logged.
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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2024
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: CRUZ, LEILA M.
FACILITY NUMBER: 214005427
VISIT DATE: 02/15/2024
NARRATIVE
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Facility provides breakfast, lunch, and a snack for children in care. Per Licensee, the facility adjusts meals for children based on allergies and food preferences.

During the visit, LPA observed the storage shed, which was converted to an infant napping room, in the Backyard. LPA inspected the napping room for any health and safety hazards. There is a carbon monoxide detector present in the room. There is a fire alarm system installed in the room. LPA will approve the addition of the room to the daycare areas, pending further department 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 inspectionprocess@dss.ca.gov. 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.



Continued on Page Three
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2024
LIC809 (FAS) - (06/04)
Page: 2 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: CRUZ, LEILA M.
FACILITY NUMBER: 214005427
VISIT DATE: 02/15/2024
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 violation issued today.
A notice of site visit was given and must remain posted for 30 days.

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

DATE: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2024
LIC809 (FAS) - (06/04)
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