414004890-2-21-2025-05-CC-JGIL-DE4QPB-20250221112029

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004890
Report Date: 02/21/2025
Date Signed: 02/21/2025 11:20:40 AM

Document Has Been Signed on 02/21/2025 11:20 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		FACILITY NUMBER:	414004890
ADMINISTRATOR/ DIRECTOR:	SOBIESKI, GRACE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 566-8595
CITY:	PACIFICA	STATE: CA	ZIP CODE:	94044
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 8	DATE:	02/21/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:30 AM
MET WITH:	Neilyn Cory Abasolo		TIME VISIT/ INSPECTION COMPLETED:	11:30 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 21, 2025, at approximately 8:30 AM, Licensing Program Analyst (LPA) Janet Gil conducted an unannounced, annual inspection. LPA met with licensee's assistant, Neilyn Cory Abasolo(A1), and explained the purpose of the inspection. Per assistant, licensee was away for an appointment at the time of inspection. Present during LPA’s visit included licensee's assistant, licensee's spouse, and 8 enrolled children (3 infants and 3 preschoolers and two school age). Four children in care are the licensee's children. The licensee is a large license and is operating within capacity limits and ratio. Licensee owns home, which is a 3 bedrooms, 3 bathroom, multi level house. Licensee lives in home with spouse, and four minor children. All adults living and working in the home have fingerprint clearance. Facility operates Monday Through Friday 8:15 AM to 5:50 PM. Day Care Areas: Lower-level Family Room, Kitchenette, Lower-level bathroom 3, Lower-level Bedroom Off Limit Areas: Entire Upper Level of the Home At approximately 9:30 AM, LPA toured day care areas of home with A1. LPA observed the home to not be kept clean and orderly. Type B deficiency is being issued on this day in accordance with the California Code of Regulations, Title 22, see LIC 809D. Home was observed to be in proper temperature and ventilation. Home is equipped with a variety of toys and materials that were observed to be in working condition. LPA observed an accessible first aid kit located in the lower level family room. LPA did not observe any accessible cleaning supplies, poisons, and solutions in day care areas. LPA observed electrical outlets to be made inaccessible with outlet covers and furniture. Home is equipped with a fully charged fire extinguisher. LPA did not observe any carbon monoxide detectors in the day care areas. Type B deficiency is being issued on this day in accordance with the California Code of Regulations, Title 22, see LIC 809D. Per A1, Licensee does not have any children in care with allergies or IMS plans. Per A1, licensee provides all foods for the children in care, and menus are posted. At approximately 10:30 AM, LPA observed bathroom for children's use was in proper working condition. LPA observed bathroom to include appropriate toileting equipment and sanitation products. LPA did not observe any hazardous materials to be accessible to children in the bathroom. Continue on Page 2...

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Janet Gil
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025

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 4

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	FACILITY NUMBER: 414004890
	VISIT DATE: 02/21/2025

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

Continued, Page 2...

The entire backyard is fully enclosed. The outdoor area is equipped with a variety of toys and materials. LPA did not observe any pools, spas, or bodies of water in day care areas. LPA observed a built in play structure with tan bark underneath. LPA observed chickens outdoors in an enclosed coop.

LPA reviewed eight children records which were complete. The children’s files have a record of emergency identification information and required immunization. Four files for the licensee's children were reviewed. LPA reviewed staff records for licensee which were complete. A1's CPR/FIrst Aide is current and will expire 1/2027. A1 and the licensee’s Mandated Reporter training certification is current. The licensee and assistant have required immunization available for review.

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 conducted at least once every six months. The last disaster drill was conducted on December 5th, 2024. 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.

Continue on Page 3...

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Janet Gil
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025

LIC809 (FAS) - (06/04)

Page: 2 of 4

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	FACILITY NUMBER: 414004890
	VISIT DATE: 02/21/2025

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

Continued, Page 3...

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://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.

On this date, 2/18/2025, 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.

During the exit interview, the licensee, Neilyn Cory Abasolo, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Two Type B deficiencies are being issued on this day in accordance with the California Code of Regulations, Title 22, see LIC 809D.

A notice of site visit was given and must remain posted for 30 days. 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's assistant, Neilyn Cory Abasolo.

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Janet Gil
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025

LIC809 (FAS) - (06/04)

Page: 3 of 4

Document Has Been Signed on 02/21/2025 11:20 AM - It Cannot Be Edited

Created By: Janet Gil On 02/21/2025 at 10:57 AM

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: SOBIESKI, GRACE	FACILITY NUMBER: 414004890
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/21/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.543

Licensure Requirements

Every family day care home for children shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 Division 12. The department shall account for the presence of these detectors during inspections. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in not having a working carbon monoxide in home, accessible to test, which poses a potential health, safety or personal rights risk to persons in care. Per Assitant, licensee has removed detector to replace batteries. Detector has still not been placed back on celing at the time of inspection.
	POC Due Date: 03/07/2025
	Plan of Correction
1 2 3 4	Assistant plans to let licensee know to place a working carbon monoxide on celing of main day care room. Assistant plans to let licenssee know to send video of working carbon monoxide detector.

Type B

Section Cited

CCR

102417(b)

Operation of A Family Child Care Home

(b) The home shall be kept clean and orderly, with heating and ventilation for safety and comfort. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in keeping the home clean and orderly which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/07/2025
	Plan of Correction
1 2 3 4	Assistant plans to licensee know home must be clean and orderly. Assistant plans to let licensee know to send pictures of home once clean and orderly to LPA Gil. Per A1 she cleans the Home Day Care areas every Friday,

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:

Garfield Leung

LICENSING EVALUATOR NAME:

Janet Gil

LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025

LIC809 (FAS) - (06/04)

Page: 4 of 4