<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004819
Report Date: 02/22/2024
Date Signed: 02/22/2024 11:22:02 AM

Document Has Been Signed on 02/22/2024 11:22 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:TAYLOR, LORENAFACILITY NUMBER:
414004819
ADMINISTRATOR:TIMOTE, LORENAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 440-1029
CITY:SAN MATEOSTATE: CAZIP CODE:
94401
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
02/22/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
08:25 AM
MET WITH:Lorena TaylorTIME COMPLETED:
11:40 AM
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 22, 2024, at approximately 8:25am, Licensing Program Analyst (LPA) Nasiripour arrived at the facility to conduct an annual inspection. LPA was granted entrance and met by Licensee, Lorena Taylor.

LPA explained the purpose of the inspection. Present in the facility was the Licensee and an Aide, Luz, 2 infants, and 5 preschool-aged children. The facility is operating within capacity limits on this day. The facility personnel summary report was reviewed with Licensee and updated during the inspection. All adults living at the facility have fingerprint clearance.

The hours of the operation are from Monday - Friday, 8:00am - 5:00pm. DAY CARE AREAS: Living Room, Bedroom #1 (Nap Room), Backyard, and Bathroom
OFF-LIMIT AREAS: Bedroom #2 (Master Bedroom and bathroom located inside master bedroom), Kitchen, and Garage. Licensee also has a in-law suite in the backyard that is fenced, locked, and off-limits. Licensee reports that during Pre-Licensing Inspection, the original report incorrectly indicated that the in-law suite was part of the day care area, although it has never been.

LPA toured day care areas of home with Licensee to inspect for health and safety hazards. LPA observed home to be clean and in good repair with proper temperature and ventilation. There were a variety of age-appropriate toys and equipment in the daycare areas which were in good condition. There is no fireplace on premises. There are no pets in the home. There are no pools or bodies of water in the premises. All cleaning supplies, poisons and other chemicals are stored inaccessible to children. Discipline Policy was discussed. Infant children sleep in pack and plays with tight-fitting sheets and preschool-aged children sleep on age appropriate mats in the living room. All enrolled infants sleep in the nap room (bedroom #1) under the supervision of the Licensee and the preschool-aged children sleep on nap mats in the living room under the Aide's supervision. The Licensee's and her Aide's CPR First Aid and Pediatric First Aid Certification all expire on 06/2025 and 01/2025.

There are two fully charged fire extinguishers, two smoke alarms, two carbon monoxide alarm, and one working telephone on site. Phone number listed for Licensee is current. Per Licensee, there are no weapons or firearms in the home. LPA reviewed seven children's' records. LPA also reviewed facility records. Licensee's and her Aide's Mandated Reporter Training are up to date and expire 06/2025. The last Emergency drill was conducted October 20, 2023. Emergency drills must be conducted at least once every six months and should be properly logged. Licensee's Emergency Drill Log is kept with all day care documents.

Continued on Page 2...
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Yasha Nasiripour
LICENSING EVALUATOR SIGNATURE: DATE: 02/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/22/2024
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: TAYLOR, LORENA
FACILITY NUMBER: 414004819
VISIT DATE: 02/22/2024
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
26
27
28
29
30
31
32
Page 2...

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Per Licensee, there are no children enrolled with allergies. Incidental Medical Services (IMS) policy was discussed. For IMS information 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: on see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the www.ada.gov/childqanda.htm.



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 child care 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 AB1207 with the Licensee. As of January 1, 2018, all staff must complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. Effective July 1, 2020, Licensees must have proof of completion of EMSA certified lead poison training if applying for a change of location or capacity change to an existing license.

LPA encouraged the Licensee to visit the Licensing website at www.ccld.ca.gov for licensing regulations and new updates. The Licensees can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.



Continued on Page 3...
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Yasha Nasiripour
LICENSING EVALUATOR SIGNATURE:

DATE: 02/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2024
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: TAYLOR, LORENA
FACILITY NUMBER: 414004819
VISIT DATE: 02/22/2024
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
26
27
28
29
30
31
32
Page 3...

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.

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 confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS prior to the Annual Inspection.

A copy of this report was given to the Licensee and a site visit notification must be posted for 30 days.

>No Deficiencies were cited today under Title 22 Division 12 of the California Code of Regulations.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Licensee, Lorena Taylor.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Yasha Nasiripour
LICENSING EVALUATOR SIGNATURE:

DATE: 02/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2024
LIC809 (FAS) - (06/04)
Page: 3 of 3