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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004962
Report Date: 11/01/2023
Date Signed: 11/01/2023 04:56:47 PM

Document Has Been Signed on 11/01/2023 04:56 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:AVENDANO, GRETEL B.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 934-8808
CITY:SOUTH SAN FRANCISCOSTATE: CAZIP CODE:
94080
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
11/01/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Ingrid Marisol, Rosa Anado, Gretel Avendano TIME COMPLETED:
05:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Andrea Medlin met with facility representative, and at the end of visit, Licensee arrived for this required annual licensing visit. There are 4 infants in care during the visit. Days and hours of operation: Monday-Friday 8:30AM-5:30PM. Licensee states she, husband, two minor children, and her mother 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. Physical plant toured to inspect for health and safety hazards. There are smoke detectors, a fully charged fire extinguisher, and a carbon monoxide (CO) detector in the home. Outdoor space inspected for health and safety hazards; outdoor play area is completely fenced. First aid supplies are available. Detergents, cleaning compounds, medications, and other items which could pose a danger to children is stored inaccessible to children. The daycare areas are kept clean and orderly and has adequate heating and ventilation for safety and comfort. Per Licensee, there are no firearms or weapons in the home. No spas, swimming pools, hot tubs, fish ponds, or similar bodies of water are present. Variety of age appropriate toys and materials is observed in the daycare. A sick child would be separated from the group and wait for parent to pick up. Licensee has current Pediatric First Aid and CPR (exp 4/6/2025). All the required licensing forms are posted. Staff and children's files reviewed. In the files reviewed, all are complete. Licensee has the required staff immunizations: measels (MMR) and pertussis (Tdap). Licensee has have verification of the mandated child abuse training compliant with AB1207 (exp 3/29/2025). Helpers do not have the required staff immunizations (measels (MMR) and pertussis (TDap) available for review during the visit. Helpers do not have verification of the mandated child abuse reporter training as compliant with AB1207.


(Continued on next pages 809-C and 809-D)
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Andrea Medlin
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: 11/01/2023
NARRATIVE
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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.

Safe Sleep - Child Care Centers and Family Child Care Homes LPA discussed the safe sleep regulations with facility representative 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 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.

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/.

(Continued on next page 809-C)

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Andrea Medlin
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2023
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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: 11/01/2023
NARRATIVE
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Licensee 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.

Megan’s Law - The facility representative confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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.

The deficiencies cited on the following pages are in violation of the California Code of Regulations, Title 22, Division 12, Chapter 1.


Exit interview conducted and report was reviewed with the licensee Gretel Avendano.

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

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Andrea Medlin
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/01/2023 04:56 PM - It Cannot Be Edited


Created By: Andrea Medlin On 11/01/2023 at 02:24 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: AVENDANO, GRETEL B.
FACILITY NUMBER: 414004962

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/01/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/14/2023
Section Cited

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On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a),
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and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met based on record review. The two helpers do not have child abuse training. This is a potential health and safety risk.
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Training can be taken at:

www.mandatedreporterca.com
Type B
11/14/2023
Section Cited

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Children's files are incomplete. See LIC 857 - Children's Record Review for a list of what is missing in each child's file. This requirement is not met based on record review and incomplete/missing forms in the children's files. This is a potential health and safety risk.
Type B
11/14/2023
Section Cited

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INFANT SAFE SLEEP: An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 month of age the provider has in care and maintained at the facility in the infant’s file. This requirement is not met as none of the infant's files have a safe sleep plan.
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:Andrea Medlin
LICENSING EVALUATOR SIGNATURE:
DATE: 11/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/01/2023


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Document Has Been Signed on 11/01/2023 04:56 PM - It Cannot Be Edited


Created By: Andrea Medlin On 11/01/2023 at 03:13 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: AVENDANO, GRETEL B.
FACILITY NUMBER: 414004962

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/01/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102425


This requirement is not met as evidenced by: Cribs or play yards shall be free from all loose articles and objects.
Deficient Practice Statement
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Based on LPA observation the licensee did not comply with the section cited above as LPA observed 3 infants in pack and plays with blankets wrapped around them. There may be absolutely nothing in the crib with infants. This poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 11/01/2023
Plan of Correction
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Deficiency cleared during visit as blankets were removed. LPA discussed safe sleep with helpers (Licensee not present during the visit, and provided a hand out on safe sleep.
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:Andrea Medlin
LICENSING EVALUATOR SIGNATURE:
DATE: 11/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/01/2023


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