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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004962
Report Date: 05/09/2023
Date Signed: 05/09/2023 08:12:38 PM

Document Has Been Signed on 05/09/2023 08:12 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:AVENDANO, GRETEL B.FACILITY NUMBER:
414004962
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
05/09/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Silvia Grimaldos GervaTIME COMPLETED:
12:05 PM
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Licensing Program Analyst (LPA) Andrea Medlin met with facility representative for this case management visit due to Licensee requesting to increase capacity to a large Family Child Care Home (FCCH). South San Francisco Fire Department has approved the fire clearance on 4/10/2023. There are 2 daycare children present during the visit; 1 infant and 1 preschool aged. Days and hours of operation: Monday-Friday 8:30AM-5:30PM. Applicant rents the home; control of property documents were reviewed and verified and on file. Licensee, husband, and two minor children reside in the home; criminal record clearance is on file for all adults in home. Licensee reminded once a person turns 18 years of age and if living or working in the daycare, criminal record clearance is required. There have been no physical plant changes in the home due to increase of capacity. This is a two level home. The entire second level is off limits to daycare children. On the second level, there is: three bedrooms and two bathrooms. On the first level (lower level) there is: family room (converted to daycare), kitchen (which has been child proofed), laundry room, bathroom, garage, living/dining room. The daycare will operate in the following areas: family room converted into daycare room, bathroom, outside small patio area adjacent to kitchen, and outside areas in backyard. There is a fully charged fire extinguisher that meets minimum requirements, smoke detectors, and a carbon monoxide (CO) detector in the home. First Aid and emergency supplies are available. Applicant will separate a sick child from the group waiting for parent to pick up. No pools, spas, hot tubs, fish ponds, or similar bodies of water are present. Licensee has current Pediatric First Aid and CPR (exp 4/6/2025) and 8 hours of Health and Safety training is on file. There are sufficient age appropriate toys and children's equipment in the day care. Bathroom is clean and hazardous material is child proofed and inaccessible to children. Licensee has verification of the required staff immunizations: measels (MMR) and pertussis (TDap). Licensee has verification of the required mandated child care reporter training as compliant with AB1207 (exp 3/29/2025).

(See next page 809-C)
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Andrea Medlin
LICENSING EVALUATOR SIGNATURE: DATE: 05/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/09/2023
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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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: AVENDANO, GRETEL B.
FACILITY NUMBER: 414004962
VISIT DATE: 05/09/2023
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If child care is provided to the 13th and 14th child, children must be school age (6 years or older), Parent Notification, and landlord consent is required. The following is required to be posted in an accessible location in view of parents: Emergency Disaster Plan (LIC 610), Parent's Rights (LIC 995A), and new License (once received).

This home meets the requirements of a Large Family Child Care Home (FCCH) and re-licensure is recommended and approved as of today, 5/9/2023.

This report is reviewed with facility representative and a copy of this report must be made available for pubic review upon request.

Notice of Site Visit posted and shall remain posted for 30 days.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Andrea Medlin
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023
LIC809 (FAS) - (06/04)
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