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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005652
Report Date: 07/21/2023
Date Signed: 07/21/2023 11:49:37 AM

Document Has Been Signed on 07/21/2023 11:49 AM - 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:SILVA, JORDANNA ESTEVES D'ABADIAFACILITY NUMBER:
214005652
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
07/21/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Jordanna SilvaTIME COMPLETED:
12:00 PM
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On 7/21/2023, Licensing Program Analyst (LPA) Hanson Leong, conducted a scheduled, pre-licensing inspection with the Applicant, Jordanna Silva. The Applicant requested a visit from the department because she applied for a Small Family Child Care license. The LPA was granted entry by the Applicant. The LPA explained the purpose of the visit to the Applicant.

The Applicant rents the home. The Applicant intends to open from 8:00 am to 5:30 pm, Monday through Friday. Before children enroll, the Applicant states that she will purchase liability insurance for her home day care. The LPA informed the Applicant that if she does not purchase insurance for her childcare, she must notify the parents using the LIC 282 form. The Applicant plans to care for children ranging in age from six months to four years old.

Daycare areas: Dining Room, Playroom, Napping room. Backyard, Son’s Room, and Bathroom

Off-limits areas: Kitchen, Licensee’s Bedroom, and Living Room.

Both LPA and the Applicant conducted a health and safety inspection of the home. The home is clean and safe, with a working smoke, carbon monoxide detector and a fire extinguisher. The Applicant has a first aid kit that is fully stocked with all the necessary supplies for treating injuries. There are no bodies of water in the home. The Applicant has garbage cans with tightly fitting covered lids. At the home, the children in care have access to age-appropriate toys and equipment. The LPA reminded the Applicant that baby walkers, bouncers, jumpers, and other similar equipment should not be used on children who are in care.

The Applicant has a designated cell phone and is aware that it must be kept in the unit during day care hours. According to the Applicant, there are no firearms or weapons in the unit. The front of the unit will be the isolation area for a sick child. All hazardous materials and toxins are kept out of children's reach and are inaccessible.

The Applicant intends to serve food to the children. The LPA observed playpens were present in the designated napping room. ***See Page 2 for continuation***

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE: DATE: 07/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/21/2023
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 3
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: SILVA, JORDANNA ESTEVES D'ABADIA
FACILITY NUMBER: 214005652
VISIT DATE: 07/21/2023
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Continued, Page 2
The LPA reminded the Applicant that the CPR and First Aid training must be renewed every two years. The Applicant has proof that she has received the MMR and TDAP vaccinations. The Applicant has completed the Mandated Reporter Training. The LPA reminded the Applicant that the Mandated Reporter Training must be renewed every two years.

The LPA informed the Applicant that emergency disaster drills should be conducted at least once every six months and that the date and time of the drill should be recorded.

Parental notification and landlord approval are required if the Applicant provides care for a seventh and eighth child who is of school age. Emergency Disaster Plan (LIC 610), Parent's Rights (LIC 995A), and License (once received) are required to be posted in an accessible location where parents can see them.

Because the Applicant rents the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).

LPA discussed the safe sleep regulations with applicant 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 [applicant, licensee, or facility representative] 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.



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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

A packet of forms pertaining to the children’s files and facility files were reviewed and discussed with the Applicant. ***See Page 3 for continuation***

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

DATE: 07/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2023
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: SILVA, JORDANNA ESTEVES D'ABADIA
FACILITY NUMBER: 214005652
VISIT DATE: 07/21/2023
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Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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

The Applicant was informed that as of September 1, 2016, a person may not be employed or volunteer at a childcare facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662. The LPA reviewed AB 1207 with the Applicant.

Applicant was informed of the MyChildCarePlan.org site, 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.


Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

The Applicant was advised to contact San Bruno Regional Office for concerns or questions. Desk Duty is available Mon-Fri, 8:00am to 5:00pm at (650) 266-8800. Forms and regulations are made available at www.cdss.ca.gov/inforesources/Community-Care-Licensing.
The LPA will not recommend a Small Family Child Care Home License for the Applicant until the following condition is met.
- Applicant obtaining fingerprint clearance

A copy of today's report was given to Jordanna Silva. An exit interview was conducted, and the report was reviewed with Jordanna Silva.

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

DATE: 07/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2023
LIC809 (FAS) - (06/04)
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