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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004954
Report Date: 09/29/2022
Date Signed: 09/29/2022 10:04:57 AM

Document Has Been Signed on 09/29/2022 10:04 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:AUGHNEY, DANA LYNNFACILITY NUMBER:
414004954
ADMINISTRATOR:AUGHNEY, DANA LYNNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 233-2265
CITY:PACIFICASTATE: CAZIP CODE:
94044
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
09/29/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:52 AM
MET WITH:Dana AughneyTIME COMPLETED:
10:15 AM
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On September 29, 2022 at 8:52 AM, Licensing Program Analyst (LPA) Cowan conducted an announced pre-licensing inspection for relocation . Present in the home this day is applicant alone. Applicant lives in the home with spouse. Applicant’s home is a rented three bedroom and three bathroom house. Day-care areas: Living Room, Dining Room, Bedroom 3, bathroom 2, and yard. Off Limit areas: Kitchen, Bedrooms 1 and 2, and garage.
Facility will operate from Monday to Friday 8:00 AM to 5:30 PM. This inspection is due to a relocation application received on 09/13/22. Licensee has a current license (#414004574), also in Pacifica.
LPA toured and inspected the house and yard for health and safety hazards. There is a fully charged 2A10BC fire extinguisher, working cellular phone, and working smoke and carbon monoxide detector in the home. Licensee has already moved some of the children’s furniture, toys, and learning material into the house. LPA observed that licensee has not fully moved into the new facility. Fireplace is blocked by a small shelf, and fire place has a child lock installed. Licensee states that the fire place will never be used. LPA observed an outdoor fire pit. Per licensee, there are no guns or weapons in the home. Licensee has a pet dog, and states that she will submit proof of vaccines for pet. Per licensee, she will provide meals for children, AM/PM snacks and lunch. LPA discussed Safe Sleep Regulations with Licensee. Licensee states that she is adhering to the regulations. Applicant’s CPR expires 7/21/21. Applicant has current Mandated Reporter on File. All required postings are posted.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: April Cowan
LICENSING EVALUATOR SIGNATURE: DATE: 09/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/29/2022
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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: AUGHNEY, DANA LYNN
FACILITY NUMBER: 414004954
VISIT DATE: 09/29/2022
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Applicants were informed about Mandated Reporter Training available on CCLD website. Training is valid for two years.
(www.ccld.ca.gov or www.mandatedreporterca.com)

Applicants were informed 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, 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.

LPA discussed the safe sleep regulations with applicants and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed [applicant, licensee, or facility representative] 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.

This facility does not plan to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. 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: http://www.ada.gov/childqanda.htm
LPA reviewed with applicant LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: April Cowan
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2022
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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: AUGHNEY, DANA LYNN
FACILITY NUMBER: 414004954
VISIT DATE: 09/29/2022
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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 platform.
To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.
Report Continues

Exit interview conducted and report was reviewed with the applicant, Dana Aughney

The following corrections will be necessary before a license to operate a small family child care license can be recommended:
  • Cover outdoor fire pit
  • Move completely in the home
  • Submit remaining required licensing documents
  • Submit Lease agreement



This report and appeal were discussed with Applicant.
For additional questions please call: San Bruno Child Care Licensing Office, M-F, 8am-5pm, 650-266-8800 or the Centralized Complaint and Information Bureau at 1-844-538-8766. Website: www.cdss.ca.gov
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: April Cowan
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2022
LIC809 (FAS) - (06/04)
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