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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004603
Report Date: 02/07/2025
Date Signed: 02/07/2025 01:38:06 PM

Document Has Been Signed on 02/07/2025 01:38 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:LITTLE ROBLES IN THE SUNSETFACILITY NUMBER:
384004603
ADMINISTRATOR/
DIRECTOR:		QUINONEZ, KIMBERLYFACILITY TYPE:
850
ADDRESS:1319 20TH AVENUETELEPHONE:
(415) 508-7313
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94122
CAPACITY: 45; 45TOTAL ENROLLED CHILDREN: 45CENSUS: 34DATE:
02/07/2025
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Kimberly QuinonezTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
NARRATIVE
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On February 07, 2025 at approximately 10:30am, Licensing Program Analysts (LPAs) Ly and Naves conducted an Unannounced Annual Visit and met with Site Director, Kimberly Quinonez during the visit. Purpose of the inspection was explained. There were 11 toddlers and 23 preschool age children 12 staff members including the Director present during today's visit. Teacher to child ratios were met on this day. The facility has fully charged fire extinguishers that meet the minimum requirements, smoke detectors, and a carbon monoxide detector. The center uses an electronic system for parents to sign their children in and out of the program.

LPAs and Site Director inspected the center for Health and Safety Hazards. There are no pools, spas or other bodies of water on the premises. Per the Site Director, there are no firearms or weapons in the center. Adequate first aid supplies are available. All cleaning supplies and other potentially harmful items are stored inaccessible to the children. Medications are stored in inaccessible to children. Furniture and equipment are in good condition, free from loose, sharp or pointed parts. Children's restrooms are in working order with adequate supplies. There are separate restrooms on site for adults. The facility provides morning and afternoon snack. Children carry their own lunches to the program. All solid waste storage containers have tight fitting lids. Drinking water is provided children's individual water bottles.

Facility has waiver granted by the department to take children to the Golden Gate Park as part of their requirement for outdoor play. Last Emergency Drill was conducted on 10/17/2024 and properly logged.

During today's visit, a random sample of children's files were reviewed. Children's files contain emergency information, required licensing forms and immunization record.

LPAs also reviewed staff files. Based on file review, Four (4) staff files did not have Physician Health Screening form (LIC 503) and clearance for Tuberculosis. Staff did not have form on file poses a potential health and safety risk to children in care. Type B deficiency has been cited on this day in accordance with the California Code of Regulations, Title 22, see LIC 809D.

Based on staff file review, staff who declined to have flu vaccine did not have written statement on file. A Technical Violation has been issued on this day. Director has been advised to have staff file a written statement for declining flu vaccine.

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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Winnie Ly
LICENSING EVALUATOR SIGNATURE: DATE: 02/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/07/2025
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: LITTLE ROBLES IN THE SUNSET
FACILITY NUMBER: 384004603
VISIT DATE: 02/07/2025
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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 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.

Facility Representative was reminded that all adults 18 and over, 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 Child Care Center. 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.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for
drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.

Facility have reached out to the department for a waiver to exempt from lead testing as facility is using water that is deliver to facility by an outside vendor.

LPA discussed the safe sleep regulations with facility representative and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Director 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.

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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Winnie Ly
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/07/2025 01:38 PM - It Cannot Be Edited


Created By: Winnie Ly On 02/07/2025 at 01:07 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: LITTLE ROBLES IN THE SUNSET
FACILITY NUMBER: 384004603

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/07/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216(g)(1)
Personnel Requirements
(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/21/2025
Plan of Correction
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Director will work to have staff record complete with form LIC 503 by due date 02/21/2025.
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:Garfield Leung
LICENSING EVALUATOR NAME:Winnie Ly
LICENSING EVALUATOR SIGNATURE:
DATE: 02/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/07/2025


LIC809 (FAS) - (06/04)
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