<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004982
Report Date: 08/29/2024
Date Signed: 08/29/2024 11:11:30 AM

Document Has Been Signed on 08/29/2024 11:11 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
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: 15CENSUS: 12DATE:
08/29/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:35 AM
MET WITH:Licensee, Maria Isabel VazquezTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On August 29th, 2024 at approximately 8:35am, Licensing Program Analyst (LPA) Tapia-Mandujano conducted unannounced inspection. LPA rang the doorbell and no one answered for approximately 3 minutes. Assistant, Denise Estrada opened the door for LPA. LPA walked in and when licensee turned around, Licensee, Maria Isabel Vazquez was arriving at the facility.

LPA explained the purpose of the visit. Present during today's inspection were licensee, assistant supervising a total of 12 children (4 infants and 8 preschoolers). At approximately 10am, Licensee's adult son arrived at the facility to help supervise the children. All adults present have fingerprint clearance and are associated.

Upon arrival, LPA conducted record review and discovered that there was one child's file that was missing and that all the files were incomplete. Type B Citation was issued.

During inspection, LPA also conducted a health and safety inspection of the home. Home appeared to be clean with proper ventilation and lighting. Children in care were found in areas for daycare use. Home was equipped with age-appropriate toys and materials for children in care.

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



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. Report was translated into Spanish by Certified Bilingual LPA Tapia-Mandujano.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE: DATE: 08/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/29/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 08/29/2024 11:11 AM - It Cannot Be Edited


Created By: Leslit Tapia-Mandujano On 08/29/2024 at 10:39 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: 08/29/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/06/2024
Section Cited
CCR
102421(a)

1
2
3
4
5
6
7
102421(a): The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d).

This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licensee will have a file for all children enrolled. Licensee will ensure that parents fill out and sign each required form that must be in each child's file.

Licensee will show proof of completion to LPA Tapia-Mandujano via email by 9/06/24.
8
9
10
11
12
13
14
Based on observation, interview, and record review, the licensee did not comply with the section cited above as there is a child present with no file and the rest of the files are incomplete which poses a potential health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE:
DATE: 08/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/29/2024


LIC809 (FAS) - (06/04)
Page: 2 of 2