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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005652
Report Date: 08/13/2024
Date Signed: 08/13/2024 03:50:37 PM

Document Has Been Signed on 08/13/2024 03:50 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:SILVA, JORDANNA ESTEVES D'ABADIAFACILITY NUMBER:
214005652
ADMINISTRATOR/
DIRECTOR:
FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 4CENSUS: 4DATE:
08/13/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:02 PM
MET WITH:Jordanna SilvaTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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On 8/13/2024, Licensing Program Analyst (LPA) Hanson Leong conducted an unannounced annual visit in conjunction with a case management visit to the Family Childcare Home (FCCH) listed above. The second reason for the visit was that the licensee had applied for a Large Family Childcare Home (FCCH) license. LPA met with the Licensee, Jordanna Silva, and explained the purposes of the visit.

Four infants and two adults (the licensee and the licensee’s assistant) were present during the visit. The two adults received criminal record clearance from the department. The licensee holds a small license and is within capacity limits and ratios.

The licensee rents the home and lives with her husband and son (under the age of 18). The hours of operation are Monday through Friday from 8:00 am to 5:30 pm.

The licensee has not obtained a signed Property Owner/Landlord Consent form (LIC9149). Without this consent, the applicant understands that, once licensed, they can operate with a maximum capacity of 6 [or 12] children. If property owner/landlord consent is obtained in the future, the applicant is advised that a new Application for a Family Child Care Home License (LIC 279) must be submitted with a change of capacity fee of $25, to increase the capacity and provide care to 8 [or 14] children.

LPA observed that all required documents, such as the facility license, the Notification of Parental Rights, and the Earthquake Preparedness Checklist, were displayed in a prominent, publicly accessible location.

The most recent emergency disaster drill was conducted on 5/10/2024, and the LPA observed that it was properly documented. LPA reviewed the emergency disaster drill log and found that they were conducted at least once every six months.

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

Off-limits Areas: the kitchen, the Licensee’s Bedroom, and the Living Room. The licensee understands that off-limits areas may not be used for childcare during business hours.

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SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE: DATE: 08/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/13/2024
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: SILVA, JORDANNA ESTEVES D'ABADIA
FACILITY NUMBER: 214005652
VISIT DATE: 08/13/2024
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LPA conducted inspections of the indoor and outdoor daycare areas to identify health and safety hazards. A fire extinguisher, a first aid kit, and multiple carbon monoxide and smoke detectors are present in the home. LPA found the home's interior to be clean and orderly, with proper heating and ventilation for safety and comfort. Disinfectants, cleaning solutions, poisons, and other hazardous items were stored in areas inaccessible to children with child safety locks. The bathroom was found to be clean and fully operational. The toilet and handwashing facility were well-kept, safe, and clean. The bathroom is equipped with appropriate toileting equipment and appropriate sanitation products.

LPA observed that the daycare areas had age-appropriate toys, furniture, and educational materials. No equipment, such as walkers, bouncers, or similar objects, was present in the home. The fireplace was observed to be properly barricaded. The home was observed to have individual permanent or portable storage space for the children’s clothing and personal belongings. Electrical outlets were observed to be properly covered with child safety covers. According to the licensee, no firearms or weapons are on the premises.

The licensee currently provides a food service that includes breakfast, lunch, and snacks. Per the licensee, no children enrolled currently have any allergies.

The backyard is enclosed by a fence and equipped with outdoor play equipment that is in good condition. The areas around and under high climbing equipment, swings, slides, and similar equipment were observed to be cushioned with grass that absorbs falls. LPA did not observe any pools, spas, or bodies of water on site.

The facility's children sleep in playpens, which were free of loose articles and materials. According to the licensee, she provides the sheets for the children and washes them weekly.



LPA reviewed four children’s files and confirmed that all four children have complete files that include their emergency contact, medical information, and fifteen-minute sleep logs.

LPA reviewed the two staff files and confirmed that all required forms were present. LPA also found that the licensee possesses a current Pediatric First Aid/CPR certification, which expires on 6/2025.

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

DATE: 08/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2024
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: 08/13/2024
NARRATIVE
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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.

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/.

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.

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, the licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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.

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

DATE: 08/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2024
LIC809 (FAS) - (06/04)
Page: 3 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: SILVA, JORDANNA ESTEVES D'ABADIA
FACILITY NUMBER: 214005652
VISIT DATE: 08/13/2024
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LPA reminded the licensee of the capacity limits specified in the license, with a review of the limits for large and small family childcare homes. It was emphasized that when no assistant provider is present, the licensee must adhere to the capacity requirements for a Small Family Childcare Home, allowing for the care of up to eight children.

LPA reminded the licensee of their obligation to be physically present and ensure continuous supervision of all children in care. In the event of temporary absence, arrangements must be made for a substitute adult to supervise the children, with absences not exceeding 20% of the facility's operating hours per day.

LPA reminded the licensee that a licensee of a large family day care home shall ensure that at least one person who has a current certificate in pediatric first aid and pediatric cardiopulmonary resuscitation shall be available at all times when children are present at the facility, or when children are off-site of the facility for facility activities.

Parental notification is required if the licensee provides care for a thirteenth and fourteenth child of school age. The Emergency Disaster Plan (LIC 610), Parent's Rights (LIC 995A), and License (once received) must be posted in an accessible location where parents can see them.

The San Rafael Fire Department issued a fire clearance for the home on 7/25/2024 in compliance with the requirements for a Large FCCH.

LPA will recommend a Large FCCH license for the licensee. The large license will take effect on 8/13/2024.

No deficiencies were issued today during LPA's visit.

A copy of today's report was given to the Licensee, Jordanna Silva.

A Notice of Site Visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Licensee, Jordanna Silva.

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

DATE: 08/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2024
LIC809 (FAS) - (06/04)
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