414004890-4-9-2024-05-CC-JGIL-D46Q9N-20240409115837

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004890
Report Date: 04/09/2024
Date Signed: 04/09/2024 11:58:46 AM

Document Has Been Signed on 04/09/2024 11:58 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:	SOBIESKI, GRACE & ALEXANDER		FACILITY NUMBER:	414004890
ADMINISTRATOR/ DIRECTOR:	SOBIESKI, GRACE & ALEXANDE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 566-8595
CITY:	PACIFICA	STATE: CA	ZIP CODE:	94044
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS:	DATE:	04/09/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:15 AM
MET WITH:	Grace Sobeski		TIME VISIT/ INSPECTION COMPLETED:	12:20 PM

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On April 9th, 2024, at approximately 10:15 AM, Licensing Program Analysts (LPAs) Janet Gil and Winnie Ly conducted an unannounced, annual inspection. LPAs met with licensee, Grace Sobeski, and explained the purpose of the inspection. Present during LPA’s visit included licensee, assistant, and 4 minor children (2 school age, 1 preschooler, and 1 infant). Per licensee, she would like to remove her spouse as the co-licensee. There were no enrolled children in care the day of visit due to them having a closed facility workday for training. Per licensee and children’s roster, licensee is a large license and has 15 enrolled children in her care with rotating schedules. Licensee stated that the maximum number of children in her care daily is 12 children.

Licensee lives in a multi-level home with her spouse and four minor children. All children present today belong to Licensee and staff. All adults living and working in the home have fingerprint clearance on file. The hours of operation are Monday through Friday 8:15 AM to 5:15 PM. All day care areas are located on the main lower level of the home.

Day-care areas: lower-level family room, kitchenette, lower-level bathroom 3, lower-level bedroom 3

Off Limit areas: Upper level kitchen, living room bedrooms 1, 2, and 3, and bathrooms 1 and 2 .

At approximately 10:30 AM, LPAs toured day care areas of home with licensee. LPAs observed the home to be in good repair with proper temperature and ventilation. Home is equipped with a variety of toys and materials that were observed to be in good working condition. LPAs observed a fully stocked accessible first aid kit. LPAs did not observe any accessible cleaning supplies, poisons, and solutions in day care areas. Home is equipped with a fully charged fire extinguisher and one carbon monoxide detector in the main day care room and one smoke detector in the lower-level bedroom 3. The licensee also has a fire alarm in the main day care room. LPAs tested carbon monoxide detector next to front door of Day Care Area, which was observed to be working. Safety locks are installed in all cabinets of the kitchenette. Licensee does not have any children in care with allergies or IMS plans. Per licensee, she provides food for all the children in her care.

LPAs observed bathroom for children's use was in proper working condition. LPAs observed bathroom to include appropriate toileting equipment and sanitation products.

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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Janet Gil
LICENSING EVALUATOR SIGNATURE:	DATE: 04/09/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024

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: SOBIESKI, GRACE & ALEXANDER	FACILITY NUMBER: 414004890
	VISIT DATE: 04/09/2024

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The entire front yard and backyard is fully enclosed. The outdoor area is equipped with a variety of toys and materials. LPAs did not observe pools, spas or bodies of water.

LPAs did not review children records due to having closed facility no enrolled children in care the day of the visit. LPAs reviewed staff records for licensee and present assistant which were complete. Licensee's CPR/FIrst Aid is current and will expire 03/2026. The licensee’s Mandated Reporter training certification is also current and will expire 12/2024. The licensee also has required immunization available for review. LPAs also observed assistant to have current CPR/First Aid that will expire on 10/2024. LPAs also observed assistant to have a valid Mandated Reporter that will expire 12/1/2025.

Licensee has licensing documentation properly posted and available for review. The licensee also maintains a childcare roster that was made available for review. Emergency disaster drills are not conducted at least once every six months. The last disaster drill was conducted in August 2023. LPAs reminded licensee to complete, and document drills every six months. Per licensee, there are no weapons or firearms in the home.

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.

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.

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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Janet Gil
LICENSING EVALUATOR SIGNATURE:	DATE: 04/09/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024

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: SOBIESKI, GRACE & ALEXANDER	FACILITY NUMBER: 414004890
	VISIT DATE: 04/09/2024

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LPAs 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-andresources/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.

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/.

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

During the exit interview, the licensee, Grace Sobeski, confirmed that there are no Registered Sex Offenders living in the facility and LPAs completed the RSO profile in FAS.

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, Grace Sobeski.

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Janet Gil
LICENSING EVALUATOR SIGNATURE:	DATE: 04/09/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024

LIC809 (FAS) - (06/04)

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