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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004807
Report Date: 12/12/2024
Date Signed: 12/12/2024 12:30:23 PM

Document Has Been Signed on 12/12/2024 12:30 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:LEIB, HAUDY A.FACILITY NUMBER:
414004807
ADMINISTRATOR/
DIRECTOR:		LEIB, HAUDY A.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(732) 763-4450
CITY:FOSTER CITYSTATE: CAZIP CODE:
94404
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
12/12/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:55 AM
MET WITH:Stephanie LeibTIME VISIT/
INSPECTION COMPLETED:
12:50 PM
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On December 12, 2024 @ approx. 8:55 am, Licensing Program Analyst (LPA) Maria Olguin-Leon met with Assistant Stephanie Leib for an unannounced annual inspection. The purpose of the inspection was explained. Present today was assistant, assistant’s spouse and 6 children (1 infant, 5 preschool age). Facility is operating within capacity limits/ratio limits. Hours of operation are Monday– Friday, 7:30 am - 5:30pm.

LPA and Licensee toured the inside and outside of home for health and safety hazards. Home is a two-story home. Day Care Areas: entrance foyer, bedroom #1(used for napping only), bathroom #1, both living rooms, kitchen/dining room on first floor and backyard. Off-limits areas: entire 2nd floor, bathroom in bedroom #1 and garage. The staircase is properly barricaded with a child proof gate for inaccessibility to 2nd floor. Kitchen cabinets are equipped with child proof latches. Home is clean, well light and has proper ventilation. Due to a leak in ceiling an area in living is equipped with childproof gates. Cleaning supplies and other potentially harmful items are stored inaccessible to children and behind child proof cabinets. All electrical outlets are secured with child proof covers. There are plenty of age-appropriate toys, books, child size furnishings, learning material, sleeping cots, and playpens. Parents provided sheets for cots and playpens and are sent home weekly for washing. Backyard has plenty of age-appropriate play toys, ride one toys, a small and large trampoline, and a small slide/climbing structure. Backyard flooring is a cement patio and real and artificial grass to cushion fall. Lagoon behind home is properly and completely fenced off with a sturdy 3 ft wood fence which equipped which has a green plastic safety mesh. Gate is secured with a chain link lock.

Home is equipped with a working carbon monoxide detector, working smoke detector and a fully charged fire extinguisher which is stored in entrance closet. Isolation area for ill children is in kitchen/dining room area and away from other children. LPA reviewed first aid kit and kit is fully stocked. Assistant uses cell phone on the premises and understands phone must remain on premises during childcare hours. Per assistant, there are no weapons or firearms in the home.

Cont. page 2…
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE: DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/12/2024
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: LEIB, HAUDY A.
FACILITY NUMBER: 414004807
VISIT DATE: 12/12/2024
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LPA reviewed 5 children’s record and 1 staff record. All children’s files are complete. Personnel files were incomplete, technical assistance issued. Facility maintains an updated Children’s roster. Assistant’s CPR/FA expires 05/2025. Mandated Reporter training for assistant was unavailable, type B deficeincy cited. Children bring their own meals from home. LPA reminded assistant to label children's food/bottles brought from home. LPA observed Childcare License, Emergency Disaster Plan (LIC610A) and Parent's rights posted. Per assistant, last emergency drill was conducted on October 1, 2024. LPA reminded Licensee to properly document conducted emergency drills, technical assistance provided. Per assistant, Licensee carries liability insurance.

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.

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/.

The Licensee was reminded about the Provider Information Notices (PINs) on the CCLD website. Licensee was informed that as of September 1, 2016, a person may not be employed or volunteer at a childcare facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662. LPA reviewed AB 1207 with the Licensee.

As of January 1, 2018, all staff must complete Mandated Reporter Training every two years. LPA reminded licensee about Mandated Reporter training available www.mandatedreporterca.com


Cont. page 3...
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
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: LEIB, HAUDY A.
FACILITY NUMBER: 414004807
VISIT DATE: 12/12/2024
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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 licensees 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. LPA reminded assistant to keep sleep logs for 3 yrs.

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

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

During the exit interview, assistant Stephanie Leib confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.



See page LIC809D for type “B” deficiency cited against the facility 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 assistant, Stephanie Leib.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/12/2024 12:30 PM - It Cannot Be Edited


Created By: Maria Olguin-Leon On 12/12/2024 at 12:20 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: LEIB, HAUDY A.
FACILITY NUMBER: 414004807

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/12/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in 1 out of 1 employee did not have mandated reporter training certificate, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/19/2024
Plan of Correction
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Assistant will email LPA mandated reporter training certificate.
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:Marie Rodriguez
LICENSING EVALUATOR NAME:Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:
DATE: 12/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/12/2024


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