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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001977
Report Date: 04/26/2024
Date Signed: 04/26/2024 04:40:56 PM

Document Has Been Signed on 04/26/2024 04:40 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:SANCHEZ, MIRNA D.FACILITY NUMBER:
384001977
ADMINISTRATOR/
DIRECTOR:		SANCHEZ, MIRNA D.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 641-8426
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
04/26/2024
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:55 PM
MET WITH:Mirna SanchezTIME VISIT/
INSPECTION COMPLETED:
04:45 PM
NARRATIVE
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On 4/26/2024 at 1:55PM., Licensing Program Analyst (LPA), Luis Gomez met with Licensee, Mirna Sanchez. Purpose of today’s visit was explained and was for an Unannounced/ Random Inspection. Present was the licensee caring for 6 children. (4 preschool-age, 2 infant-age). Adults present have criminal record clearances on file. Per licensee, the days and hours of operations are: Monday- Friday 8:00 AM.- 6:00 PM. The areas of the home used for childcare are the Living Room/ Playroom; Kitchen; Bathroom #1; Hallway (Pass through only) and Backyard Area. Area designated as off-limits is Bedroom #1. LPA inspected home for health and safety hazards.

At 2:05PM., the following was observed: Facility has age-appropriate playthings available for the children. LPA reminded licensee to ensure hallway remains clear of hazards. Accessible furniture, toys, puzzles and books were in good repair. LPA observed a table and several chairs, scaled to the proper size. Bathroom #1 was maintained clean with fixtures in operating condition. Facility was a comfortable temperature with ventilation and adequate lighting.

For nap services, LPA observed cribs and beds in playroom. The cribs inspected were equipped with tight-fitting mattresses and sheets. Per licensee, napping linens are washed weekly. The off-limit areas have been made inaccessible. The detergents, cleaning compound, toxins and items which pose a danger have been stored inaccessible to children. Licensee’s home had functioning telephone service; carbon monoxide/ smoke detector combination detector; and fire extinguisher: 2A:10BC.

At 2:25PM., LPA inspected the backyard area. Areas was completely enclosed, with turf flooring installed for added safety. LPA reminded licensee to remove all hazardous plants from backyard area. Home does not have any pools, fishpond, jacuzzi, or bodies of water. (REFER TO 809c, FOR CONT)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 04/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/26/2024
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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Document Has Been Signed on 04/26/2024 04:40 PM - It Cannot Be Edited


Created By: Luis Gomez On 04/26/2024 at 04:08 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SANCHEZ, MIRNA D.
FACILITY NUMBER: 384001977

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/26/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(c)
(c) An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 month of age the provider has in care and maintained at the facility in the infant’s file.

This requirement is not met as evidenced by:
Deficient Practice Statement
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At 3:15PM., Based on record review, LPA confirm 'Individual Infant Sleeping Plan' (LIC9227) missing from qualifying infant's (C1) file. This poses a potential health and safety risk to children in care.
POC Due Date: 05/03/2024
Plan of Correction
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Licensee will ensure completed LIC9227, Individual Infant Sleeping Plan, is stored in infant (C1's) files.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Marie Rodriguez
LICENSING EVALUATOR NAME:Luis Gomez
LICENSING EVALUATOR SIGNATURE:
DATE: 04/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/26/2024


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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: SANCHEZ, MIRNA D.
FACILITY NUMBER: 384001977
VISIT DATE: 04/26/2024
NARRATIVE
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(Page 2)
At 2:35PM., LPA reviewed the facility records including children files. The children’s files were reviewed and included: Identification and Emergency Information (LIC700); Notification of Parent’s Rights (LIC995); Health History; and Immunization Records.

Licensee is documenting napping conditions every 15 minutes for infant-age children in care.

At 3:15PM., Based on record review, LPA confirm 'Individual Infant Sleeping Plan' (LIC9227) missing from qualifying infant's (C1) file.

Licensee’s ‘Mandated Reporter Training’ certification (AB1207) was current expiring: 6/2025.
Required emergency disaster drill was conducted during inspection (3/25/2024) and logged by the licensee.

At 3:45PM., Based on record review, LPA confirmed licensee missing proof of Cardiopulmonary Resuscitation / First Aid Certification. Advisory Note: Technical Violation (LIC9102TV) was issued.

Required forms are posted in facility, including the Facility License, Notification of Parent’s Rights (PUB379), and Emergency Disaster Plan.

Per licensee, isolation of an ill child is in the playroom. Per licensee, the program provides all food services for children in care. (REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2024
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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: SANCHEZ, MIRNA D.
FACILITY NUMBER: 384001977
VISIT DATE: 04/26/2024
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Licensee was reminded that all adults 18 years and over living in the home, person who provides care and supervision to children, and staff who have contact with children, including employee and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain criminal 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 Child Care Licensing Safe Sleep Web page at:https://www.cdss.ca.gov/inforesource/child-care-licesning/public-information-and-resources/safe-sleep as an additional resource. LPA informed licensee of the importance of checking for recalled infant devices on United States consumer Product Safety Commission (CPSC) website at http://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 www.mychildcareplan.org site is a consumer education website that helps families obtain child care by connecting to child care providers and resources and referral agencies (R&R) throughout California.

Incidental Medical Services (IMS) policy was discussed. For IMS information, see PIN 20-02-CCP. When an IMS is provided, a plan for 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- 0382 (TTY) and link to publications: Commonly asked questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm
(REFER TO 809c, FOR CONT.)
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2024
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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: SANCHEZ, MIRNA D.
FACILITY NUMBER: 384001977
VISIT DATE: 04/26/2024
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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 tool, please send them 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/inforesource/community-care-licensing/inspection-process.

Based on today's inspection, deficiencies were observed in areas evaluated according to California Title 22, Div. 12 Chap. 3, Health and Safety, Code of Regulations and cited on 809D. Exit interview including the plan for correction; and facility evaluation report was reviewed with Licensee, Mirna Sanchez. Licensee’s signature of this form acknowledges the receipt of these documents.

During exit interview, licensee, Mirna Sanchez confirmed that there are no registered sex offenders living in the facility, and LPA completed the RSO profile. Notice of site visit was given and must remain posted for 30 days.

This report must be available in the facility for public review. Notice was provided and shall remain posted for 30 days. The licensee was advised for additional questions to call CCL Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2024
LIC809 (FAS) - (06/04)
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