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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002882
Report Date: 01/30/2025
Date Signed: 01/30/2025 11:02:21 AM

Document Has Been Signed on 01/30/2025 11:02 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:PFS-BAYSHORE OUR SECOND HOME CDC (PS)FACILITY NUMBER:
414002882
ADMINISTRATOR/
DIRECTOR:		FLOR HERNANDEZFACILITY TYPE:
850
ADDRESS:725 PRICE STREETTELEPHONE:
(650) 301-3304
CITY:DALY CITYSTATE: CAZIP CODE:
94014
CAPACITY: 16TOTAL ENROLLED CHILDREN: 13CENSUS: 13DATE:
01/30/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Flor HernandezTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
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On January 30, 2025 at approximately 8:45am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, annual inspection. LPA met with site supervisor, Flor Hernandez, and explained the purpose of the visit. Upon LPA's arrival included site supervisor and associate teacher. Children were lining up outside facility.

Program is a part time program that operates Monday through Friday 9:00am to 12:00pm. Program operates Fall through Summer of each year at Our Second Home Facility in classroom #1 and fully fenced outdoor area only.

With site supervisor, LPA inspected day care areas for health and safety hazards. LPA observed classroom to be clean and organized. LPA observed exit doors to classroom to have a sound alarm system installed. There are rugs in the classroom that are clean, free of stains. Per site supervisor, rugs are vacuumed daily. LPA observed classroom to have a variety of children's toys, materials, and furniture in good condition. Per site supervisor, toys and materials are rotated every two months.

LPA observed children's toys and materials to be labeled and organized. Classroom includes areas for reading, arts and crafts, dramatic play and building blocks. There are cabinets and drawers in the classroom that are appropriately labeled. LPA observed cabinets and drawers in classroom to have child safety locks installed. LPA observed cleaning solutions and chemicals to be stored in classroom's high shelves, labeled, and inaccessible to children.

At approximately 9:00am, children were arriving to facility. Present during LPA's visit included 13 preschool children. Program is operating within capacity limits and ratio during LPA's visit.

Storage for children's belongings are located inside the classroom, labeled with children's names and pictures. Children's restroom was observed to be in working condition and equipped with appropriate sanitation materials. Per site supervisor, there are children currently in diapers. Children's families provide diapers and wipes, if needed, that are stored in children's cubbies. LPA observed garbage bins in children's restroom and classroom to have tight fitting lids.
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SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE: DATE: 01/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/30/2025
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 3
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: PFS-BAYSHORE OUR SECOND HOME CDC (PS)
FACILITY NUMBER: 414002882
VISIT DATE: 01/30/2025
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Classroom includes a fully charged fire extinguisher, fully stocked first aid kit, emergency backpack, emergency supplies, fire alarm system, fire sprinklers, and multiple smoke and carbon monoxide detectors. LPA was unable to test carbon monoxide detector during today's visit, due to detectors being placed in high ceilings. Per site supervisor, detectors are hard wired throughout entire facility and were recently tested.

Outdoor area is fully enclosed and fenced. There is a storage shed in the outdoor area that is locked. LPA observed outdoor area to have a variety of toys and materials that are in good condition. There is a play structure that has resilient padding underneath. LPA walked on play structure during visit. LPA determined play structure can sustain the weight of an adult.

Drinking water is available both in doors and outdoors with children's individual water bottles that can be refilled on site through a pitcher (also refilled on site through sink).

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.

LPA verified that the lead testing was completed in accordance to the Written Directives
outlined in PIN 21-21.1-CCP.

Program provides a food service that includes snack only. Food is prepared and delivered to facility daily. LPA observed snack menu to be properly posted and available for review. Utensils and plates are disposed of daily at facility. Due to program being a part time program, children do not have naptime at facility.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. When any IMS is provided, an updated Plan of Operation that includes 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 are available at: https://www.ada.gov/resources/child-care-centers/

Children are signed into and out of program with authorized representatives' electronic signatures. LPA observed children present to be signed into program, upon arrival. Site supervisor was also able to provide LPA with sign in/out records for week of 1/20/2025. Sign in/out records include the time the child is signed into and out of program.
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SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2025
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: PFS-BAYSHORE OUR SECOND HOME CDC (PS)
FACILITY NUMBER: 414002882
VISIT DATE: 01/30/2025
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LPA reviewed 6 random children's records. Children's records are complete with emergency contact information, admission information and immunization records. Site supervisor maintains a child care roster that was made available for LPA's review.

LPA observed licensing documents to be properly posted in English and Spanish, available for review. Emergency disaster drills are conducted monthly and are appropriately documented. Last disaster drill was conducted January 10, 2025.

LPA reviewed teaching staffs' files. Both site supervisor and teacher present have a current CPR/First Aid certification that was made available for LPA's review. Teaching staff present also have records of their required immunizations, educational transcripts/permits and current Mandated Reporter certifications. LPA reminded site supervisor, mandated reporter training must be completed and renewed every two years by all staff working with children.

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.

Facility representative 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.

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 facility representative, Flor Hernandez.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2025
LIC809 (FAS) - (06/04)
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