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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004874
Report Date: 04/29/2022
Date Signed: 04/29/2022 12:50:16 PM

Document Has Been Signed on 04/29/2022 12:50 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:VIDAL-NORIEGA, BETTY J.FACILITY NUMBER:
414004874
ADMINISTRATOR:BETTY J. VIDAL-NORIEGAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 576-8398
CITY:SAN BRUNOSTATE: CAZIP CODE:
94066
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
04/29/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Betty Vidal-NoriegaTIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Andrea Medlin met with applicant for this prelicensing visit. Purpose of visit explained. Days and hours of operation will be Monday-Friday 7:00AM-5:30PM. The San Bruno Fire Department has condcuted their fire inspection, however licensing does not have a copy of the approved fire clearance as of to date. LPA to follow up with fire department regarding the approval. Applicant states she and husband are the only ones who reside in the home. Control of property documents reviewed and obtained during the visit; applicant owns the home. Applicant advised that any person 18 years of age or older who lives here, or provides any care and supervision to daycare children, shall have criminal record clearance on file. The entire home is inspected for health and safety hazards. This is a two level home. The areas used for daycare will be: on lower level, main daycare "activity" room, smaller daycare room used mostly for younger children and will be used for infants napping, the bathroom next to main daycare room (the laundry area in bathroom is separated by gate to prevent children's access), and the gated section area in backyard. The children may not use the areas outside beyond the separated child gate nor use the deck on upper level (street level/main level of home). Off limits areas consists of: the entire upper/street level of home, the downstairs garage area and one bedroom. There are safety knobs on these doors to prevent children access. The upstairs area consists of: master bedroom, two bedrooms, two bathrooms, kitchen/dining area, and living room. The home has working smoke detectors, fire extinguishers, and carbon monoxide (CO) detectors. First aid kit/supplies are available. Applicants will use a separated area for isolation of ill/sick children which will be a corner in the living room until picked up by parent/guardian. Per applicant, there is one dog in the home which will be kept separate from the daycare. Per applicant, there are no firearms or weapons in the home. No pools, spas, hot tubs, fish ponds, or similar bodies of water are present. Per applicant, she plans to purchase liability insurance for the child care; if child care insurance is not purchased, each parent must be given the Affidavit Regarding Liability Insurance for Family Child Care Home (LIC 282).

(Continued on next page 809-C)
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Andrea Medlin
LICENSING EVALUATOR SIGNATURE: DATE: 04/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/29/2022
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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: VIDAL-NORIEGA, BETTY J.
FACILITY NUMBER: 414004874
VISIT DATE: 04/29/2022
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There are sufficient age appropriate toys and children's equipment available. Bathroom is clean and hazardous materials are inaccessible to children. Applicant advised to conduct emergency disaster drills at least once every six months and log the date and time of the drill. If applicant provides care to the 13th and 14th child, who must be school aged, parent notification is required.

The following is required to be posted in an accessible location in view of parents: Emergency Disaster Plan (LIC 610), Parent's Rights (LIC 995A), and License.

Prior to licensure, the following is needed for final approval:
  • Copy of approved San Bruno Fire Department fire clearance for (STD 850)
  • Applicants fingerprints pending clearance

Once the above is obtained, LPA will recommend approved licensure and then license will be sent.


This report is reviewed with applicant and a copy of this report must be available for public review upon request.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Andrea Medlin
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2022
LIC809 (FAS) - (06/04)
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