214005664-1-4-2024-05-CC-JTSE-CZ6QZE-20240104113636

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 214005664
Report Date: 01/04/2024
Date Signed: 01/04/2024 11:36:51 AM

Document Has Been Signed on 01/04/2024 11:36 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	COLINDRES HURTARTE, RAYZA F.		FACILITY NUMBER:	214005664
ADMINISTRATOR:	COLINDRES HURTARTE, RAYZA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 250-6819
CITY:	CORTE MADERA	STATE: CA	ZIP CODE:	94925
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	01/04/2024
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Applicant, Rayza Colindres Hurtarte		TIME COMPLETED:	11:45 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 1/4/2024, at approximately 9:00AM, Licensing Program Analyst (LPA) Jonathan Tse conducted an announced prelicensing visit at the home. LPA was granted entry to the home by Applicant, Rayza Colindres Hurtarte. LPA explained the purpose of the visit. Present in the home was the Applicant and Applicant’s stepson. All adults living or working in the home have acquired fingerprint clearance and are associated to the assigned facility number. The building is a two-level, four-bedroom, three-bathroom home, with a detached ADU in the Backyard. Per Applicant, the ADU will be used as the primary day care area. Daycare Areas: Backyard and ADU, which includes a Play Area, Nursery, Bathroom #1 and Kitchen. Off-limits Areas: Entirety of the main home. Off-limits areas are secured by locked doors or gates. Applicant was notified that any changes to daycare areas or off-limits areas must be approved by the Department. Applicant plans to operate Monday to Friday, 8AM to 5PM. Applicant plans to take care of children between the ages of five months and five years old. LPA observed the ADU to be kept in clean and orderly condition. LPA observed there to be sufficient temperature and ventilation in the ADU. The Play Area and Nursery are currently not completely furnished with day care materials and equipment. Per Applicant, they will be setting up a bookshelf, diaper changing station, and multiple cribs. There is a carbon monoxide detector and a smoke detector present in the Play Area that are both operational. LPA observed a 1A10BC fire extinguisher present in the Play Area. LPA discussed requirement to have a fire extinguisher that is at least size 2A10BC. All cabinets and drawers that would be accessible to children have been secured with childproof locks. The Bathroom sink and toilet were observed to be operational. Continued on Page Two

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024

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 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: COLINDRES HURTARTE, RAYZA F.	FACILITY NUMBER: 214005664
	VISIT DATE: 01/04/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Page Two
The Backyard was observed to be clean and free of loose debris. There is sufficient cushioning for children in the form of artificial turf. Applicant stated that a section of the Backyard would be gated to store equipment and grills away from children in care. There are stairs present in the Backyard that would also be secured from children. Applicant has a pet dog that has access to the Backyard from the Home via a doggy gate. Applicant demonstrated that the doggy gate can be secured by a cover. The pet dog would not have access to children during operating hours.

Parents will provide food from home. Food preparation and allergies was discussed with Applicant.

Applicant was reminded baby walkers, bouncers, jumpers, and any other similar items are not to be used for children in care. LPA reminded applicant emergency disaster drills are to be conducted and documented at least once every six months.

Applicant's CPR/First Aid training is current and will expire 11/2025. Applicant's Mandated Reporter training certification is also current and will expire 9/2025. LPA reminded applicant CPR/First Aid training and Mandated Reporter training must be renewed every two years. Applicant was also reminded Mandated Reporter training must be renewed every two years by all staff working with children. Applicant has proof of required immunizations that were provided to department. Per applicant, there are no weapons or firearms in the home.

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.

Continued on Page Three

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024

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: COLINDRES HURTARTE, RAYZA F.	FACILITY NUMBER: 214005664
	VISIT DATE: 01/04/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Page Three
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.

LPA reviewed with applicant the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant.

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-and-resources/safe-sleep, as an additional resource. LPA also informed 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.

On this date, 1/4/2024, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly
cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

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.
Continued on Page Four

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024

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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: COLINDRES HURTARTE, RAYZA F.	FACILITY NUMBER: 214005664
	VISIT DATE: 01/04/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Page Four
The following corrections must be made prior to licensure:

Applicant shall acquire a fire extinguisher that is fully charged and is at least size 2A10BC.
Applicant shall submit photos of the fully furnished ADU to LPA.
Applicant shall submit photos of gates installed in Backyard (stairs and attached to ADU) to LPA.
Applicant shall submit an updated LIC999 (Facility Sketch) of the main home to LPA.

Exit interview conducted and report was reviewed with the applicant, Rayza Colindres Hurtarte.

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.

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024

LIC809 (FAS) - (06/04)

Page: 4 of 4