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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414001089
Report Date: 08/29/2024
Date Signed: 08/29/2024 11:50:48 AM

Document Has Been Signed on 08/29/2024 11:50 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:MUNOZ, TERRI ANNFACILITY NUMBER:
414001089
ADMINISTRATOR/
DIRECTOR:		MUNOZ, TERRI ANNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 834-0181
CITY:SAN BRUNOSTATE: CAZIP CODE:
94066
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
08/29/2024
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Licensee,TerrI Ann MunozTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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On August, 29 2024 at approximately 9:15am, Licensing Program Analyst’s (LPA) Melissa Zaragoza conducted an unannounced, annual inspection. LPA was greeted and granted access by licensee’s assistant, Cassandra Torres. Per staff, licensee is upstairs and will come down. At the entrance assistant was explained the purpose of the inspection. Present during LPA's visit included Licensee, 2 staff assistants, and 10 children (3 infants and 7 preschool age).

Hours of operation are Monday through Friday 7:30am to 5:00pm. Licensee lives in a two-level home with their adult son. All adults living in the home and staff present, have fingerprint clearance on file.

The DAY CARE AREAS are located on the first level of the home, that includes the hallway for walk through only, bedroom #1, bedroom #2(napping room), family room, and the entire backyard. The OFF LIMIT AREAS are the entire second level of home. Off limit areas are made inaccessible with child safety gates.

LPA toured day care areas of home with licensee. LPA observed home to be in good repair with proper temperature and ventilation. Home is equipped with a variety of toys and materials that were observed to be in good condition. LPA observed cleaning supplies, poisons and hazardous materials to be stored in home's high shelves.

Home is equipped with a fully charged fire extinguisher and a smoke and carbon monoxide detector. Smoke and carbon monoxide detector were tested during visit and was observed to be in working condition. There are no pools, and bodies of water in the premises.

Napping room (bedroom#2) was observed to be equipped with playpens for napping children. Playpens were observed to be free of loose articles, bumper pads and pillows. LPA observed Cots for napping preschool aged children. Sleeping logs for napping infants are maintained and includes the 15-minute time check of when infant was last checked on and sleeping position.


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SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE: DATE: 08/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/29/2024
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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: MUNOZ, TERRI ANN
FACILITY NUMBER: 414001089
VISIT DATE: 08/29/2024
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Bathroom was observed to be in proper working condition. There is appropriate sanitation and toileting equipment for children in care. LPA observed children’s diapers and wipes in children’s individual cubbies. Per licensee, children’s families provide diapers and wipes for enrolled children. LPA observed garbage cans fully secured with lids on them.

Children eat in bedroom #1. A food service is provided to children that includes water and snack only. Per licensee, children’s parents provide lunch to children in care. LPA observed eating area to be clean and equipped with appropriate dining furniture. Per licensee, there are no children with dietary restriction or allergies.

Outdoor area is entirely enclosed and fenced. Outdoor area includes a variety of toys and equipment that were in good condition. Stairs in backyard were made inaccessible with a child safety gate. LPA did not observe any pools, spas or bodies of water on site.

LPA reviewed 6 random children's records which were complete. LPA reviewed licensee’s and all staff who were present records, which were complete. Licensee has a current CPR/First Aid certification and current Mandated Reporter certifications. Licensee's CPR/First Aid certification expires on 6/11/2026 and Mandated Reporter certifications will expire 09/09/2025.

Emergency disaster drills are conducted and are appropriately documented. Last drill was conducted July 20th 2024. LPA observed licensing documentation to be properly posted, made available for review. Facility maintains a childcare roster that was also made available for review. Per licensee, there are no weapons or firearms in the home.

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: Marie Rodriguez
LICENSING EVALUATOR NAME: Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024
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: MUNOZ, TERRI ANN
FACILITY NUMBER: 414001089
VISIT DATE: 08/29/2024
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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.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://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.

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/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the licensee, Terri Ann Munoz, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed a Megan’s Law search on 08/19/2024.

No deficiencies were issued during today's visit. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Terri Ann Munoz.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024
LIC809 (FAS) - (06/04)
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