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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004887
Report Date: 11/17/2023
Date Signed: 11/17/2023 11:06:10 AM

Document Has Been Signed on 11/17/2023 11:06 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:KERRIGAN, DANA ELIZABETHFACILITY NUMBER:
414004887
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
11/17/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:25 AM
MET WITH:Dana KerriganTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Andrea Medlin met with licensee for this case management visit due to requested increase in capacity to a large child care home. There are 5 children present during the visit; 3 infants and 2 preschool aged. Days and hours of operation: Monday-Friday 6:30AM-5:00PM. South San Francisco Fire Department has approved the fire clearance on 11/9/2023. Licensee rents the home; control of property documents were reviewed and are on file. Licensee and boyfriend are the only ones living in the home; criminal record clearance is on file for all adults. The daycare will operate in the following areas: Main Dining Room/Kitchen, Bathroom, Side Drive Way (outdoor space), and Living Room (Pass through only). The off limits areas are: all bedrooms. LPA inspected outdoor space which is off to the side of house in the front. It is fully fenced and gated. There is a separate area for a child who is sick and needs to be isolated. There is a fully charged fire extinguisher that meets minimum requirements, smoke detectors, and a carbon monoxide (CO) detector in the home. First Aid and emergency supplies are available. No pools, spas, hot tubs, fish ponds, or similar bodies of water are present. Per licensee, there is one dog in the home (not present during operating hours as the dog goes to dog daycare). Per licensee, there are no firearms or weapons are in the home. Licensee has current Pediatric First Aid and CPR and 8 hours of Health and Safety training is on file. There are sufficient age appropriate toys and children's equipment in the day care. Bathroom is clean and hazardous material is child proofed and inaccessible to children. Licensee has verification of the required staff immunizations: measels (MMR) and pertussis (TDap). Licensee has verification of the required mandated child care reporter training as compliant with AB1207. Licensee has purchased liability insurance for the child care. If child care is provided to the 13th and 14th child, children must be school age (6 years or older), Parent Notification, and landlord consent 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 new License (once received).

(Continued on next pages 809-C)
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Andrea Medlin
LICENSING EVALUATOR SIGNATURE: DATE: 11/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/17/2023
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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: KERRIGAN, DANA ELIZABETH
FACILITY NUMBER: 414004887
VISIT DATE: 11/17/2023
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Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

The licensee provided proof of control of property. Licensee rents and has landlord consent: Because the licensee rents the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. When any IMS is provided, an updated Plan of Operation that includes 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Review of records to be maintained - Family Child Care Homes LPA reviewed with applicant the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep, as an additional resource.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Andrea Medlin
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2023
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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: KERRIGAN, DANA ELIZABETH
FACILITY NUMBER: 414004887
VISIT DATE: 11/17/2023
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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.

On this date, 11/14/2023 the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Licensee was informed of the MyChildCarePlan.org site, 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.

Subscribe to CCLD important information - Child Care Centers and Family Child Care Homes: Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms.

To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.


This home meets the requirements of a Large Family Child Care Home (FCCH) and re-licensure is recommended and approved as of today, 11/17/2023. Exit interview conducted and report was reviewed with the applicant Dana Kerrigan. Notice of site visit issued and shall remain posted for 30 days.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Andrea Medlin
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2023
LIC809 (FAS) - (06/04)
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