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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004982
Report Date: 10/15/2024
Date Signed: 10/15/2024 04:12:27 PM

Document Has Been Signed on 10/15/2024 04:12 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 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: 14CENSUS: 0DATE:
10/15/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:45 PM
MET WITH:Licensee, Maria Isabel VazqiezTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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On October 15th, 2024 at 2:45pm, Licensing Program Manager (LPM) Marie Rodriguez and Licensing Program Analyst (LPA) Leslit Tapia-Mandujano met with licensee, Maria Isabel Vazquez for an informal office meeting. Present during meeting included licensee and licensee's husband.

The purpose of the informal meeting was to address licensee's non-compliance with facility. LPA Tapia-Mandujano investigated two separate complaints in concurrent with a Case Management-Deficiencies Inspection. During the Inspections, LPA cited on separate dates, three Type A citations and two type B citations.

On 7/11/24, citations received and discussed were:
· Criminal Record Clearance: 102370(d): Fingerprint Clearance
· Operation of a Family Child Care Home: 102417(g)(4): Dangerous Chemicals/compounds accessible to children
· Personnel Records: 102416(c): CPR & First Aid
· Infant Safe Sleep: 102425(b): Objects in play yards

On 8/29/24, citations received and discussed were:
· Child's Records: 102421(a): Children’s file

On 7/11/24, LPA Leslit Tapia-Mandujano substantiated and cited the following Type A citation:
· Operation without a License: 102357: Operation of a Family Child Care Home at a separate address

On 9/26/24, LPA Leslit Tapia-Mandujano substantiated and cited the following Type A citation:
· Definitions: 102352: Licensee living in the home

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SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE: DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/15/2024
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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: VAZQUEZ, MARIA ISABEL
FACILITY NUMBER: 414004982
VISIT DATE: 10/15/2024
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Licensee was advised and reminded of the following:
· Licensee must live in the home that is operating a Family Child Care Home
· Licensee must be present in the home 80% of operating hours, a day.
· Licensee must ensure that all adults present and/or living in the home must obtain fingerprint clearance and be associated to licensed facility.
· Licensee is responsible and liable for anything that occurs in the home even if an employee is present.
· Licensee must inform CCLD of any room change to home and be approved by Caseload LPA prior to using or removing a room.
· Licensed must comply with ensuring day care areas are free of any potential hazards.
· Licensee must maintain all required documentation for all children and employees who are present in the home.
· Licensee must comply with all safe sleep regulations.

Licensee stated they are aware of the importance to be in compliance with all licensing regulations. Department will conduct additional visits to licensee's home to verify licensee's compliance with regulations.

During meeting, licensee was provided Safe Sleep Regulations, Operation of a Family Child Care Home Regulations, Inspection Authority of the department, Health and Safety Code 1596.803, and forms and records to maintain for employees and children in the home (LIC 311D) including translated forms in Spanish.

Exit interview conducted and report was reviewed and translated into Spanish by LPA Tapia-Mandujano to licensee, Maria Isabel Vazquez.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024
LIC809 (FAS) - (06/04)
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