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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414005110
Report Date: 06/26/2024
Date Signed: 06/26/2024 12:11:54 PM

Document Has Been Signed on 06/26/2024 12:11 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:PEREIRA, MARIA LUIZAFACILITY NUMBER:
414005110
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
06/26/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:10 AM
MET WITH:Applicant, Maria Luiza PereiraTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On June 26, 2024 at approximately 9:00am, Licensing Program Analyst (LPA) Melissa Zaragoza and Licensing Program Manager (LPM) Marie Rodriguez conducted a scheduled, pre-licensing inspection. LPA met with applicant, Maria Luiza Pereira, and explained the purpose of the inspection. Present during LPA's visit included applicants’ spouse and 2 minor children.

Applicant submitted an application for a family childcare home on May 14, 2024. Applicant lives in the multi-level home with their spouse and 2 minor children. Applicant plans to operate Monday through Friday 7:00am to 5:30pm. Applicant plans to care for children ages 3 months to school age. Applicant is aware children living in the home under 10 years old, are counted towards overall capacity and 18 and over need finger print back ground check.

With applicant, LPA inspected the entire home, inside and outside, for health and safety hazards. The home is a two-level home that consists of 3 bedrooms, 3 bathrooms, living room, dining area, kitchen, laundry room, downstairs (FCCH area), backyard and garage.

The DAY CARE AREAS located on the entire first/ground level of the home. Which is the playroom, bathroom #1, hallway (for walk though only), small room in hallway, and backyard. The OFF LIMIT AREAS are the entire second level of home which includes bedroom #2, bedroom #3, bathroom #3, stairs to go up, kitchen, living room, and dining room. First level of the home: Bedroom #1, bathroom #2, laundry room, and garage. Off limit areas are made inaccessible with child safety door handles and safety gates. Stairs leading up to second level of home is inaccessible with a child proof gate.

LPA observed the day care area to be clean and safe. Home is equipped with a fully charged fire extinguisher that was observed to be secured to wall. Home is equipped with a smoke and carbon monoxide detector. During visit, LPA tested a smoke and carbon monoxide detector that was observed to be working.

Day care areas were observed to be equipped with a variety of toys, materials and furniture that were age appropriate. Furniture to store children’s toys is stabled, locked, and secured to the wall. Furniture cannot be moved. LPA observed electrical outlets to be made inaccessible with safety covers.
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SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE: DATE: 06/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/26/2024
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 4
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: PEREIRA, MARIA LUIZA
FACILITY NUMBER: 414005110
VISIT DATE: 06/26/2024
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Kitchen was observed to be clean and safe. Cabinets and drawers were also observed to have child safety locks installed. Knives and sharp objects are made inaccessible. Bathroom was observed to be in proper working condition. Bathroom is equipped with age-appropriate toileting equipment and sanitation products. Art material are store in home high cabinets.

The backyard area is entirely enclosed and fenced. LPA observed backyard to have a variety of toys and equipment that were age appropriate. Backyard has fake grass flooring, a play structure with swings for children to play, and sand box. LPA 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, taking a break, and communicating with children's families. The designated isolation area will be half of the playroom. Applicant plans to split the playroom in half using a child proof gate. One side of the playroom will have the rest of the children in the FCCH, and the other side will be for the child who is feeling sick. LPA reminded applicant; children must be always supervised. Applicant plans to provide a food service that includes lunch and snacks. Food preparation, sanitization, and children's allergies were discussed.

Applicant's CPR/First Aid training is current and will expire 08/2025. Applicant's Mandated Reporter training certification is also current and will expire 11/29/2026. 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 (MMR, Tdap and Flu) that were provided to LPA. Per applicant, there are no weapons or firearms in the home.

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SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2024
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: PEREIRA, MARIA LUIZA
FACILITY NUMBER: 414005110
VISIT DATE: 06/26/2024
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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, has not obtained a signed Property Owner/Landlord Consent form (LIC9149). Without this consent, the applicant understands that, once licensed, they can operate with a maximum capacity of 6 children. If property owner/landlord consent is obtained in the future, the applicant is advised that a new Application for a Family Child Care Home License (LIC 279) must be submitted with a change of capacity fee of $25, to increase the capacity and provide care to 8 children.

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) 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, 05/14/2024, 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.


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SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2024
LIC809 (FAS) - (06/04)
Page: 4 of 4
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: PEREIRA, MARIA LUIZA
FACILITY NUMBER: 414005110
VISIT DATE: 06/26/2024
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Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Exit interview conducted and report was reviewed with the applicant, Maria Luiza Pereira.

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 at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

As of today’s date 06/26/2024 Applicant will be approved for licensing a Family Child Care Home.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2024
LIC809 (FAS) - (06/04)
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