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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004926
Report Date: 10/24/2023
Date Signed: 10/24/2023 05:52:10 PM

Document Has Been Signed on 10/24/2023 05:52 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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:CAMPOS, LIDIANA & CAMPOS, OLEANDROFACILITY NUMBER:
414004926
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
10/24/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Lidiana CamposTIME COMPLETED:
05:55 PM
NARRATIVE
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On 10/24/2023, Licensing Program Analysts (LPAs) Leong and Tso, made an unannounced annual visit to the Family Child Care Home listed above in conjunction with a case management visit. The LPAs were granted entry by the Licensee, Lidiana Campos. Ms. Campos requested a visit from the department to increase capacity from eight (Small License) to fourteen children (Large License). The LPAs explained the purposes of the visit to Ms. Campos. All individuals listed on the facility’s roster have been granted permission to work or be present in a childcare facility. The LPAs observed Ms. Campos supervising four infants. The facility is operating within its capacity and in accordance with the required ratio of staff to children. The second licensee, Mr. Campos arrived during the LPA’s inspection of the physical plant.

Day-care Areas: Entire downstairs, Bathroom and Backyard.

Off Limit Areas: Garage, and Entire Upstairs.



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The LPAs and Ms. Campos both performed careful inspections of the daycare facility to look for any potential health and safety hazards. Toys and equipment that are suitable for children of the proper age range are provided at the daycare. The building has sufficient lighting and ventilation, and it is free of any defects or conditions that put children at risk. The facility is equipped with a first aid kit that is completely loaded with everything that is required for the treatment of injuries. The daycare facility is equipped with a smoke detector, a carbon monoxide detector, and a fire extinguisher. Every garbage can and power outlet has been covered. Products for cleaning and washing, detergents, and any other materials that could put children in danger are stored out of the children’s reach. The LPAs did not find any walkers, bouncers, or other comparable objects during today’s inspection. According to Ms. Campos, there are no firearms or other weapons in the home. The LPAs found that the facility did not have any pools, spas, or other types of bodies of water of any kind. The LPAs found the bottom portion of the bouncer in the backyard is surrounded by a net. The LPAs observed the facility did not have a 2A10BC fire extinguisher, which is required for a family child care home. (Pending for a large license) ***See Page 2***
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE: DATE: 10/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/24/2023
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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Document Has Been Signed on 10/24/2023 05:52 PM - It Cannot Be Edited


Created By: Hanson Leong On 10/24/2023 at 04:29 PM
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: CAMPOS, LIDIANA & CAMPOS, OLEANDRO
FACILITY NUMBER: 414004926

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/24/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensees did not comply with the section cited above which poses a potential health, safety or personal rights risk to children in care.
POC Due Date: 11/07/2023
Plan of Correction
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The Licensees states they will complete the preventative health course by the above due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Daniel J Oquendo
LICENSING EVALUATOR NAME:Hanson Leong
LICENSING EVALUATOR SIGNATURE:
DATE: 10/24/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/24/2023


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: CAMPOS, LIDIANA & CAMPOS, OLEANDRO
FACILITY NUMBER: 414004926
VISIT DATE: 10/24/2023
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There is a designated space for children to sleep or rest quietly. The area has sufficient sleeping equipment and cots for each child, and all mattresses and bedding are stored in the appropriate location. According to Ms. Campos, parents are responsible for providing bedding and other necessary sleeping equipment. The LPAs reminded Ms. Campos that emergency exits must always remain clear, and that cots and cribs cannot be situated in a manner that blocks emergency exits.

The LPAs observed that the facility had posted all the required forms, including the facility license, Notification of Parental Rights, and Earthquake Preparedness Checklist. The LPAs reminded Ms. Campos that smoking is not permitted in a family childcare facility.



The LPAs reviewed both the children's and staff records. The LPAs reviewed the records of the four children and found three of the children contain immunization information, along with the names, addresses, and phone One child was missing their immunization information, along with the names, addresses, and phone. The LPAs reminded all children must have all required documents in their file, form LIC 627, form LIC 700, form LIC 995a, and their immunization record. The LPAs reviewed the sleeping records of the children under the age of two and determined that the data was properly recorded. Following a review of the staff records, the LPAs found that the two licensees possess a valid Pediatric First Aid/CPR certification. The LPAs also found that the two licensees possess up-to-date certification in Mandated Reporter training. During today’s visit, the LPAs did not find the preventative health certification in the files of the two licensees, which is required for a Family Child Care Home. (Refer to LIC 809D for citation)

The LPAs reviewed the facility's emergency drill log. According to the facility’s emergency drill log, the earthquake drill was carried out on 10/18/203.

Ms. Campos 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. ***See Page 3**

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023
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: CAMPOS, LIDIANA & CAMPOS, OLEANDRO
FACILITY NUMBER: 414004926
VISIT DATE: 10/24/2023
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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/.

LPAs discussed the safe sleep regulations with Ms. Campos 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 Ms. Campos 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.

Ms. Campos 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, Ms. Campos confirmed that there are no Registered Sex Offenders living in the facility and LPAs completed the RSO profile in FAS.

On 10/24/2023, 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.

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. ***See Page 4***

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023
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: CAMPOS, LIDIANA & CAMPOS, OLEANDRO
FACILITY NUMBER: 414004926
VISIT DATE: 10/24/2023
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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.

Ms. Campos has not obtained a signed Property Owner/Landlord Consent form (LIC9149). Without this consent, Ms. Campos understands that, once licensed, they can operate with a maximum capacity of 12 children.

Parental notification is required if Ms. Campos provides care for a 13th and 14th child who is of school age. Emergency Disaster Plan (LIC 610), Parent's Rights (LIC 995A), and License (once received) are required to be posted in an accessible location where parents can see them.

The Central County Fire Department issued a fire clearance for the home on 10/4/2023, as necessary for a Large Family Child Care Home

The LPAs will not recommend a Large Family Child Care Home License for Ms. Campos until Ms. Campos obtains a 2a10bc fire extinguisher.


f
Please refer to LIC 809D for today’s citation.

A copy of today’s report and the facility’s appeal rights were given to Oleandro Campos. The Notice of Site Visit was given to Oleandro Campos and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Exit interview conducted and report was reviewed with Oleandro Campos.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023
LIC809 (FAS) - (06/04)
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