414004462-2-19-2025-05-CC-MZAA-DE2QZJ-20250219113650

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004462
Report Date: 02/19/2025
Date Signed: 02/19/2025 11:40:39 AM

Document Has Been Signed on 02/19/2025 11:40 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:	PORTILLO, JESSICA J.		FACILITY NUMBER:	414004462
ADMINISTRATOR/ DIRECTOR:	PORTILLO, JESSICA J.		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 766-6443
CITY:	BURLINGAME	STATE: CA	ZIP CODE:	94010
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 11	DATE:	02/19/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:00 AM
MET WITH:	Licensee, Jessica Portillo		TIME VISIT/ INSPECTION COMPLETED:	12:00 PM

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 February 19, 2025 at approximately 9:00am, Licensing Program Analyst (LPA) Zaragoza conducted an unannounced annual inspection. LPA was greeted and granted access by licensee, Jessica Portillo. At the entrance licensee was explained the purpose of the inspection. Present during LPA's visit included Licensee, 4 staff, and 11 children (5 infants and 6 school age). Hours of operation are Monday through Friday. 8:30am to 5:30pm. Licensee lives in a two-level home alone. All adults living in the home and staff present, have fingerprint clearance on file. The DAY CARE AREAS are the living room, dining room, napping room, bathroom #1, and backyard. The OFF LIMIT AREAS are the kitchen, all the 2^nd level, and the garage. Off limit areas are made inaccessible with child safety door handles and 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 electrical outlets to be made inaccessible with child safety covers. Cleaning supplies, poisons and hazardous materials are stored in home's high shelves and/or locked behind child safety locked cabinets. Home is equipped with a fully charged fire extinguisher and dual 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 was observed to be equipped with playpens and cots for napping children. LPA observed playpens to have mattresses with tight fitting sheets. Sleeping logs for napping infants are maintained and includes the 15 minute time check of when infant was last checked on. Per licensee, they provide sheets and blankets. Sheets and blankets are washed weekly. 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 to be properly maintained in changing table. Per licensee, parents provide diapers and wipes for enrolled children. (Continue Report on Page 2...)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE:	DATE: 02/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025

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

FACILITY NAME: PORTILLO, JESSICA J.	FACILITY NUMBER: 414004462
	VISIT DATE: 02/19/2025

NARRATIVE

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Children eat in dining area. A food service is provided to children that includes lunch and snacks. LPA observed eating area to be clean and equipped with appropriate dining furniture. LPA observed knives to be made inaccessible.

LPA reviewed 11 children's records which were complete. LPA reviewed licensee and all staff who were present records. LPA reminded the licensee Mandated Reporter training certificate must be renewed every two years, LPA cited 1 Technical assistants. Licensee has a current CPR/First Aid certification. Licensee's CPR/First Aid certification expires 05/2026.

Emergency disaster drills are conducted and are appropriately documented. Last disaster drill was conducted on 2023. LPA reminded the licensee, disaster drills are to be conducted every 6 months, LPA cited 1 Technical Assistant. 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.

There is one deficiency sited during today’s inspection. Per California Code of Regulations, Staffing Ratio and Capacity 102416.5 (Title 22, division 12 & Chapter 1) (b)(2) One-Type A citation.

LPA Zaragoza informed Licensee, Jessica Portillo that this report dated 02/19/2025 document(s) (1) Type A citation(s) which shall be posted for 30 consecutive days as there is immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Zaragoza informed the licensee to provide a copy of this licensing report dated 02/19/2025 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

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.

(Continue Report on Page 3...)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE:	DATE: 02/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025

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: PORTILLO, JESSICA J.	FACILITY NUMBER: 414004462
	VISIT DATE: 02/19/2025

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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 child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the licensee, Jessica Portillo, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed a Megan’s Law search on 02/19/2025.

Based on interviews, observations and record review, the licensee did not comply with California Code of Regulations Title 22 102416.5(b)(1). The licensee is being cited 1 Type A violation. See attached 809D.

Exit interview conducted and report was reviewed with the licensee, Jessica Potillo

Licensee was provided with appeal rights.

A notice of site visit form was given and must remain posted for 30 days.

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE:	DATE: 02/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 02/19/2025 11:40 AM - It Cannot Be Edited

Created By: Melissa Zaragoza On 02/19/2025 at 11:16 AM

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: PORTILLO, JESSICA J.	FACILITY NUMBER: 414004462
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/19/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

102416.5(d)(1)

Staffing Ratio and Capacity

(d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either: (1) Twelve children, no more than four of whom may be infants; or This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above by having a total of 5 infants children and 6 preschool children, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 02/19/2025
	Plan of Correction
1 2 3 4	Per licensee, they plan to let go of 1 infant child in order to stay within capacity limits.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Melissa Zaragoza

LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025

LIC809 (FAS) - (06/04)

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