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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005610
Report Date: 01/22/2024
Date Signed: 01/22/2024 01:59:57 PM

Document Has Been Signed on 01/22/2024 01:59 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:SOUZA, KARINAFACILITY NUMBER:
214005610
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
01/22/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Karina SouzaTIME COMPLETED:
02:10 PM
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On January 22, 2024, Licensing Program Analyst (LPA) Garcia conducted an announced inspection for increase of capacity and met with licensee, for her request to increase from a Small to a Large Family Child Care Home. Fire Clearance was received from Central Marin Fire Department on January 8, 2024. Present in the home are licensee and her husband, with a total of 4 children in care. All adults living and working in the home have fingerprint clearance and are associated to the facility.

Licensee rents the home, which is a 2 bedroom and 1 bathroom home with a covered patio. Licensee lives with her husband, 1 adult and 1 minor children. The hours of operation are Monday through Friday from 8:00 am- 5:00pm. LPA and licensee inspected day care areas for health and safety hazards. LPA observed that there are age appropriate furniture and toys.

Day-care areas are: Living Room, 2 bedrooms, Bathroom, patio.
Off limit areas are: Kitchen. All off limit areas, including all closets are properly barricaded.

The home is equipped with a smoke detector, carbon monoxide, and a fire extinguisher size 3A40BC located in the closet. LPA advised the licensee to conduct emergency drills once every six months and keep a log sheet. The facility provides morning snacks, lunches, and afternoon snacks.

LPA observed home to be clean and in good repair with proper temperature and ventilation. There are a variety of age appropriate toys and equipment in the home which are in good condition. Patio is fenced and properly barricaded. All cleaning supplies, poisons, and other chemicals are stored inaccessible to children. There is 1 fully charged fire extinguisher, and a working telephone. Per Licensee, there are no pets in the home Licensee's CPR & First Aid expires on 03/2025 and madated reporter training certificate expires 03/2024. Postings were posted next to the main door. Licensee is reminded of no walkers, exersaucers, jumpers, bouncers and any similar items to be used for children in care and shall be made inaccessible. Capacity limits of a Small and Large Family Child Care Home were explained.

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SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Nathan Garcia
LICENSING EVALUATOR SIGNATURE: DATE: 01/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/22/2024
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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: SOUZA, KARINA
FACILITY NUMBER: 214005610
VISIT DATE: 01/22/2024
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LPA discussed the safe sleep regulations with the applicant and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed the applicant 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. LIC9227 and infant sleep log was discussed.

LPA will recommend for approval of a Large Family Child Care Home License as of today, January 22nd, 2024.

No deficiencies were cited today under CCR, Title 22, Div. 12, Chapt. 1.

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

Exit interview was conducted and report was reviewed by licensee, Karina Souza.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Nathan Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2024
LIC809 (FAS) - (06/04)
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