414005042-8-31-2023-05-CC-CQUO-CV8RE3-20230831125653

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414005042
Report Date: 08/31/2023
Date Signed: 08/31/2023 12:56:58 PM

Document Has Been Signed on 08/31/2023 12:56 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	SOARES, ANDREA B.		FACILITY NUMBER:	414005042
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	08/31/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Andrea Soares		TIME COMPLETED:	01:15 PM

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 31, 2023 at approximately 9:30am, Licensing Program Analysts (LPAs) Catrina Quimbo and Jonathan Tse, conducted a scheduled, pre-licensing inspection. LPAs met with applicant, Andrea Soares, and explained the purpose of the visit. Present in the home were applicant, applicant's adult daughter, and one minor child applicant was caring for. Applicant submitted a family child care home application August 1, 2023. Applicant lives in the single level home with their adult daughter and minor daughter. Per applicant, their adult daughter will be moving out of the home by the end of week 8/28/2023. Applicant is currently pending fingerprint clearance. Applicant plans to operate Monday through Friday 8:00am to 5:00pm. Applicant plans to care for children up to 3 years old. With applicant, LPAs inspected the entire home, inside and outside, for health and safety hazards. The home is a single-level home that consists of 3 bedrooms, 1.5 bathrooms, living room, dining area, kitchen, front yard, side yard, back yard, outdoor storage unit (converted into classroom) and storage closet in storage unit. The DAY CARE AREAS are the living room, dining area, kitchen, bedroom #3, both bathrooms, side yard, back yard, and outdoor storage unit/classroom. The OFF LIMIT AREAS are bedroom #1 (located directly in front of bathrooms), master bedroom and storage closet in converted classroom. Off limit areas are made inaccessible with locked doors. Applicant was notified any off limit areas are not to be used as a day care area without prior approval from the department. LPAs observed the day care areas to be clean and safe. Home is equipped with multiple fully charged fire extinguishers and fully stocked emergency backpack with first aid kit. There are multiple dual smoke/carbon monoxide detectors in bedrooms and hallway that was observed to be working. Kitchen cabinets, drawers with sharp objects, and stove were observed to have child safety locks installed. LPAs observed day care areas to be equipped with a variety of age appropriate toys, materials and furniture that was in good working condition. LPAs observed electrical outlets in day care areas to be made inaccessible with child safety locks. (Continue Report on Page 2...)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023

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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SOARES, ANDREA B.	FACILITY NUMBER: 414005042
	VISIT DATE: 08/31/2023

NARRATIVE

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Bathrooms were observed to be in proper working condition. LPAs observed poisons, chemicals and other hazardous materials behind child safety locked cabinets in bathroom. Toilet was observed to be properly equipped with age appropriate toileting equipment.

The outdoor area includes a side yard and backyard. Backyard was observed to be fully fenced and enclosed with an at least 5 ft. high fence. LPAs did not observe any pools, spas or bodies of water on site.

Applicant was reminded baby walkers, bouncers, jumpers and any other similar items are not to be used for children in care. LPA reminded applicant emergency disaster drills are to be conducted and documented at least once every six months.

Applicant's discipline policy will be redirection and changing environment. The designated isolation area will be living room, separate from other children in care. LPA reminded applicant, children must be supervised at all times. Applicant plans to provide a food service that includes snacks, lunch and dinner. Food preparation, sanitization, children's allergies was discussed.

Applicant's CPR/First Aid training is current and will expire 03/2024. Applicant's Mandated Reporter training certification is also current and will expire 06/2025. LPA reminded applicant CPR/First Aid training and Mandated Reporter training must be renewed every two years. Applicant was also reminded Mandated Reporter training must be renewed every two years by all staff working with children. Applicant has proof of required immunizations that were provided to department. Per applicant, there are no weapons or firearms in the home.

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

The applicant provided proof of control of property. Because the applicant rents/leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).
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SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023

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: SOARES, ANDREA B.	FACILITY NUMBER: 414005042
	VISIT DATE: 08/31/2023

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This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. 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) or (800) 514- 0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

LPA reviewed with applicant the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance checklist was provided to the applicant.

LPA discussed the safe sleep regulations with applicant 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 applicant 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.

On this date, 08/02/2023, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Applicant was informed of the MyChildCarePlan.org site, 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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website athttps://www.cdss.ca.gov/inforesources/community-carelicensing/ subscribe and select the Child Care option to receive email communication.

Prior to recommended licensure, following must be completed:
-Fingerprint clearance for all adults living in the home.
-Posting of licensing documentation.
-Installation of window stoppers on windows in living room.
-Sound alarm installation on both gates in side yard.

Exit interview conducted and report was reviewed with the applicant, Andrea Soares.

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023

LIC809 (FAS) - (06/04)

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