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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004584
Report Date: 08/26/2024
Date Signed: 08/26/2024 03:46:41 PM

Document Has Been Signed on 08/26/2024 03:46 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:CARDENAS, EDELMIRAFACILITY NUMBER:
414004584
ADMINISTRATOR/
DIRECTOR:		CARDENAS, EDELMIRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 305-9477
CITY:ATHERTONSTATE: CAZIP CODE:
94027
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
08/26/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:55 PM
MET WITH:Licensee, Edelmira CardenasTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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On August 26th, 2024, at 12:55pm, Licensing Program Analyst (LPA) Tapia-Mandujano conducted an unannounced Annual inspection and met with licensee Edelmira Cardenas. Upon arrival Licensee let LPA in through the front entrance of the facility and explained the purpose od the inspection. Present in the facility are Licensee supervising 10 children (3 infants and 7 preschool age children). During inspection, facility is within capacity limits. All adults living and working in the facility are fingerprint cleared and associated.

Licensee owns the home and lives with her two Adult sons. Home is a 3 bedroom, 2 bathroom, single level house. The hours of operation are Monday-Friday from 8am-5pm Daycare area: Living room, Playroom, Bathroom #2, and Side yard. OFF limit area: Dining Area, Kitchen, Laundry area, Bedroom #1, Bathroom #2, Master Bedroom #2, Bedroom #3, Garage, Back yard, and second side yard. All off limit areas, including all closets are properly barricaded.

LPA observed the Day-care is clean, orderly with a variety of age-appropriate toys for the children. All furniture inspected is in good repair. The applicant has a fully stocked First Aid kit and was reminded to be aware of the expiration on the First Aid Kit. The home has no pools or bodies of water in the home. The home has a fireplace that is properly barricaded. Per licensee there are no pets in the home. The home has age-appropriate equipment available for children in care. Licensee was reminded that baby walkers, bouncers, jumpers and any other similar items are not to be used for children in care. LPA observed infant children to sleep in cribs. LPA observed cribs to be free of loose of objects and/or articles. LPA reminded licensee about safe sleep regulations. LPA observed licensee is maintaining safe sleep logs.

There was a fully charged fire extinguisher, A dual smoke alarm and carbon monoxide alarm, and a working telephone which is the Licensees cell phone. Phone number listed for Licensee is current. Per Licensee, there are no weapons or firearms in the home.



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SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE: DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/26/2024
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: CARDENAS, EDELMIRA
FACILITY NUMBER: 414004584
VISIT DATE: 08/26/2024
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LPA reviewed children’s records which were complete. Licensee's Mandated reporter training Expires on 072026 and Licensees Pediatric CPR/First Aid certification Expires on 01/2026.

All the required posting documentation, such as the facility license, Notification of Parental Rights and have been placed in a prominent area for parents or representatives to review. According to licensee emergency drills are conducted at least once every six months. The last emergency drill was conducted on 8/01/2024. LPA reminded licensee to properly document emergency drills.

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 atwww.cdss.ca.gov/inforesources/community-care-licensing/inspection-process

Licensee 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 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 at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/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.

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SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2024
LIC809 (FAS) - (06/04)
Page: 2 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: CARDENAS, EDELMIRA
FACILITY NUMBER: 414004584
VISIT DATE: 08/26/2024
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Incidental Medical Services (IMS) policy was discussed. Licensee does not offer IMS at this time. 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, Edelmira Cardenas, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS on 8/26/24.

No deficiencies were cited today under CCR, Title 22, Div. 12, Chapt. 1.



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

Exit interview conducted and report was reviewed with the licensee, Edelmira Cardenas.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2024
LIC809 (FAS) - (06/04)
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