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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004982
Report Date: 07/11/2024
Date Signed: 07/11/2024 12:21:39 PM

Document Has Been Signed on 07/11/2024 12:21 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:VAZQUEZ, MARIA ISABELFACILITY NUMBER:
414004982
ADMINISTRATOR/
DIRECTOR:		VAZQUEZ, MARIA ISABELFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 284-9261
CITY:EAST PALO ALTOSTATE: CAZIP CODE:
94303
CAPACITY: 14TOTAL ENROLLED CHILDREN: 7CENSUS: 7DATE:
07/11/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:45 AM
MET WITH:Maria Isabel VazquezTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
NARRATIVE
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On July 11, 2024 at approximately 10:45am, Licensing Program Analyst, (LPAs) Tapia-Mandujano and Olguin-Leon conducted an inspection and met with Licensee, Maria Isabel Vazquez. Facility is operating within capacity limits. Not all adults present and/or living in the home have criminal background clearances and/or are associated with facility.

During the inspection, it was determined and confirmed by licensee, that there were two unfingerprinted adults living and/or working in the child care facility. At approximately 9:54am, LPA's observed cleaning compounds, chemicals, detergents, and medication to be accessible to children in care in Bedroom #1& #2, and the Laundry room. LPAs confirmed assistant does not have CPR/First Aid certification. Due to this determination, there was an immediate health and safety risk for the children in care. Please see LIC 809D for more details and deficiencies cited today.

During the health and safety inspection, LPAs observed that there were multiple blankets inside and on the side of the pack and plays which poses a potential health and safety hazard. Due to this determination, regulation is cited, please see LIC 809D for more details and deficiencies cited today.

Licensee has requested to remove Bedroom #1 as part of Day care area, Bedroom #4 is not set up and ready for day care use. Licensee will not use that room until it is free of all potential hazards.

New Daycare areas are: Front living rooms (2), Bedroom# 2, Bedroom #4, Bathroom #2 (inside Bedroom #2), Bathroom #3, Dining room, Laundry Room (diaper changing only), and front yard. OFF limit areas: Kitchen, Bedroom #1, Bathroom#1 (inside Bedroom #1), Bedroom #3, Backyard, and Garage. All off limit areas are properly barricaded, including all closets.

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SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE: DATE: 07/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/11/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 07/11/2024 12:21 PM - It Cannot Be Edited


Created By: Maria Olguin-Leon On 07/11/2024 at 10:32 AM
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: VAZQUEZ, MARIA ISABEL
FACILITY NUMBER: 414004982

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/11/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
07/12/2024
Section Cited
CCR
102370(d)

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102370(d): Criminal Record Clearance: All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:

This requirement is not met as evidenced by:
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Licensee will ensure that all adults living and/or working in the facility will have fingerprint clearance and are associated prior to being present in the facility.

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Based on observation, interview and record review, the licensee did not comply with the section cited above as there is two adults (A1 and A2) living and/or working in the home that did not have criminal background clearance or associated, which poses an immediate health, safety or personal rights risk to persons in care.
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Office Meeting will be scheduled for the future.
Type A
07/12/2024
Section Cited
CCR102417(g)(4)

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102417(g)(4): Operation of a Family Child Care Home: Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

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Licensee will ensure that all chemicals, detergents and medications are made inaccessible to children behind child proof cabinets or out of reach to children in care.
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Based on observations, the licensee did not comply with the section cited above, as LPAs observed detergents, medications and chemicals in Bedroom #1 & #2, and Laundry Room which were accessible to children in care which poses an immediate health, safety or personal rights risk to persons in care.
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Licensee has removed all the chemicals, detegents, medications, and/or potential hazardous objects to an off limit area or an out of reach cabinet.

Deficiency will be cleared.
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:Marie Rodriguez
LICENSING EVALUATOR NAME:Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:
DATE: 07/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/11/2024


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Document Has Been Signed on 07/11/2024 12:21 PM - It Cannot Be Edited


Created By: Maria Olguin-Leon On 07/11/2024 at 10:52 AM
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: VAZQUEZ, MARIA ISABEL
FACILITY NUMBER: 414004982

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/11/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/19/2024
Section Cited
CCR
102416(c)

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102416(c): Personnel Records: 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:
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A1 will either stop supervising children alone or take CPR & First Aid training.

Licensee will send proof of enrollment of the training for A1 to LPA Tapia-Mandujano email by the end of the day on July 19th, 2024.
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Based on observation, interview, and record review, facility did not comply with the section cited above as Assistant (A1) was left alone with children and she does not have CPR & First Aid Certificate which poses an immediate health, safety or personal rights risk to persons in care.
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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:Marie Rodriguez
LICENSING EVALUATOR NAME:Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:
DATE: 07/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/11/2024


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Document Has Been Signed on 07/11/2024 12:21 PM - It Cannot Be Edited


Created By: Maria Olguin-Leon On 07/11/2024 at 11:01 AM
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: VAZQUEZ, MARIA ISABEL
FACILITY NUMBER: 414004982

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/11/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/11/2024
Section Cited
CCR
102425(b)

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102425(b):INFANT SAFE SLEEP: (b) Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidence by :
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LPAs reminded licensee of the Safe Sleep regulations.

Licensee has removed all the blankets from the play yards.

Defiency will be cleared.
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Based on observations, LPAs Tapia-Mandujano and Olgiun-Leon observed Bedroom #2 had play yards with mulltiple blankets inside and on the side of the play yards which poses a potential health, safety or personal rights risk to persons in care.
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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:Marie Rodriguez
LICENSING EVALUATOR NAME:Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:
DATE: 07/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/11/2024


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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: VAZQUEZ, MARIA ISABEL
FACILITY NUMBER: 414004982
VISIT DATE: 07/11/2024
NARRATIVE
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Page 2 Continued...

***California Code of Regulations, (Title 22, Div. 12, Ch 3) were cited on this day.

Three type “A” violations were issued today. Licensee is advised to provide a copy of the Evaluation Report and all Type “A” Deficiencies cited, to the parents and guardians of children currently enrolled in care and to parents of newly enrolled children during the next 12 months. A signed and dated LIC 9224 shall be maintained in all Children's files. Notice of site Visit will be posted and should remain posted for 30 days, failure to post will result in an immediate civil penalty.

This report must be available in the facility for public review. An exit interview was conducted with licensee, Maria Isabel Vazquez. Appeal Rights were provided. LPA Tapia-Mandujano translated the report to licensee in Spanish.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2024
LIC809 (FAS) - (06/04)
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