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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004926
Report Date: 10/30/2024
Date Signed: 10/30/2024 03:30:56 PM

Document Has Been Signed on 10/30/2024 03:30 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:CAMPOS, LIDIANA & CAMPOS, OLEANDROFACILITY NUMBER:
414004926
ADMINISTRATOR/
DIRECTOR:		CAMPOS, LIDIANA & OLEANDROFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 834-6483
CITY:MILLBRAESTATE: CAZIP CODE:
94030
CAPACITY: 12TOTAL ENROLLED CHILDREN: 7CENSUS: 5DATE:
10/30/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:27 PM
MET WITH:Lidiana CamposTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
NARRATIVE
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On October 30, 2024, at approximately 12:30 pm, Licensing Program Analyst (LPA) Zeynep Basak conducted an unannounced annual inspection and met the Licensee, Lidiana Campos. LPA explained the purpose of the inspection to the Licensee.

LPA observed the licensee and the assistant supervising 5 children (4 infant, 1 toddler). The licensee complies with the licensing capacity during the time of inspection. The children's roster has been reviewed and found to be complete and up to date.

LPA verified with the Guardian Roster that all present adults have criminal clearance and are associated. According to the licensee, there are no changes to the previously approved childcare areas and off-limit areas.

Day care area(s): Entire downstairs, Bathroom and Backyard

Off-limits area(s): Garage, and Entire Upstairs.

LPA observed the home to be clean and in good repair with proper temperature and ventilation. There are two working smoke detectors, carbon monoxide detectors, and 2 fully charged fire extinguisher, one in size 2A10BC. The childcare home has a functioning telephone. Per the licensee, there are no firearms, guns, or weapons in the home.


The licensee stated they provide breakfast, lunch, morning, and afternoon snacks, in addition to drinking water.

See page 2.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Zeynep Basak
LICENSING EVALUATOR SIGNATURE: DATE: 10/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/30/2024
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: CAMPOS, LIDIANA & CAMPOS, OLEANDRO
FACILITY NUMBER: 414004926
VISIT DATE: 10/30/2024
NARRATIVE
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Page 2.
LPA and the Licensee inspected the childcare areas for health and safety hazards. The childcare area is clean and free from hazards. LPA observed all cleaning supplies, and other chemicals are stored properly and inaccessible to children. LPA observed a daycare area is equipped with age-appropriate furniture, toys, books, and educational materials.

Five cribs were observed in the napping area. LPA was reviewed and reminded to licensee the sleep log, to check infant children every 15 minutes during naptime. The Licensee understood and acknowledged that no baby walkers, bouncers, or other similar items are permissible to be used during daycare hours. LPA confirmed with the licensee they have an isolation area in the corner of the daycare forl children to wait until their parents arrive.

LPA reviewed the 5 children's file and found some LIC 995 and LIC 613A are missing. LPA reminded the licensee to have them signed and placed in children file.
LPA also reviewed the assistant's file and found some immunization records (MMR and Tdap) not in the file. The licensee could not provide them to review during LPA visit. The licensee stated assistant has them but don't have access her records electronically and she will provide it by the end of this week. Technical Assistance was issued.
LPA observed the licensee has valid CPR+First Aid expiring on 7/2026, and both the licensee and the assistant have valid Mandated Reporter training.

Per the licensee, the emergency drills are conducted at least once every six months, and the latest drill was on September 10, 2024.

LPAs observed all mandatory postings are posted in Childcare Home including License, Parent's Rights.

See page 3.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Zeynep Basak
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2024
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: CAMPOS, LIDIANA & CAMPOS, OLEANDRO
FACILITY NUMBER: 414004926
VISIT DATE: 10/30/2024
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Licensees were reminded about the Provider Information Notices (PINs) on the CCLD website. The licensee was informed that as of September 1, 2016, a person may not be employed or volunteer at a childcare facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.

The licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPAs discussed the safe sleep regulations with the licensee and discussed the Child Care Licensing Safe Sleep webpage https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed the 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. Per licensees there was no child present has an allergy at the facility. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: www.ada.gov/childqanda.htm.
See page 4.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Zeynep Basak
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2024
LIC809 (FAS) - (06/04)
Page: 3 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: CAMPOS, LIDIANA & CAMPOS, OLEANDRO
FACILITY NUMBER: 414004926
VISIT DATE: 10/30/2024
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LPAs reviewed AB 1207 with the Licensees. As of January 1, 2018, all staff must complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

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

During the exit interview, the LICENSEE, Lidiana Campos confirmed that there are no Registered Sex Offenders living in the facility, and LPA completed the RSO profile in FAS.

A notice of site visit was given and must remain posted for 30 days.

An exit interview was conducted, and the report was reviewed with the licensee, Lidiana Campos.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Zeynep Basak
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2024
LIC809 (FAS) - (06/04)
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