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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414005190
Report Date: 01/14/2025
Date Signed: 01/14/2025 03:44:46 PM

Document Has Been Signed on 01/14/2025 03:44 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:MACHADO, GISELLEFACILITY NUMBER:
414005190
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
01/14/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:49 AM
MET WITH:Giselle MachadoTIME VISIT/
INSPECTION COMPLETED:
03:55 PM
NARRATIVE
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On January 14, 2025 at approximately 9:00am, Licensing Program Analysts (LPA) Alvarado conducted a scheduled pre-licensing inspection. LPA met with applicant, Giselle Machado, and explained the purpose of the visit. Present during today’s Inspection is Applicant and husband.

Applicant submitted a family child care home application to the department on December 2, 2024. Applicant lives in a one floor apartment with Husband and Son. To get to the facility, you have to walk up one flight of stairs. Applicants Husband Cecilio Machado DeSouza is the name on the lease agreement and Applicant has submitted a declaration of residence for the facility for Parma LLC.

Applicant plans to operate Monday through Friday 7:30am to 5:30pm. Applicant plans to care for children ages 2 months to 10 years old. With applicant, LPAs inspected the entire home, inside and outside, for health and safety hazards.

The home is a one-level apartment that requires one flight of stairs to het to the entrance, consists of 2 bedrooms, 1 bathrooms, living room, dining room, kitchen, Garage, and Back Yard.

DAY CARE AREAS: Living room (Main Day Care Area), Bathroom, Room #2 (Pass through only to outdoor area), and Only the enclosed outdoor area within the tan picket fence.

OFF LIMIT AREAS: Dining Room, Kitchen, Hallway Closet, Laundry Room, Bedroom #1, the outer part of the enclosed outdoor area, and Garage.

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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Diana Alvarado
LICENSING EVALUATOR SIGNATURE: DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/14/2025
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: MACHADO, GISELLE
FACILITY NUMBER: 414005190
VISIT DATE: 01/14/2025
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LPA observed the day care areas to be clean and safe. Home is equipped with a fully charged 2A:10-B:C fire extinguisher and fully stocked First Aid Kit. There are multiple smoke detectors and carbon monoxide detectors in the home that LPAs observed to be working.

LPA observed the wall heater vent to be in the living room that was properly barricaded, Day care areas to be equipped with a variety of age-appropriate toys, materials and furniture that are good working condition. Sharp edges on furniture were observed that applicant properly covered with rubber end. LPA observed electrical outlets in day care areas to be made inaccessible with child safety covers. Flooring in home includes of wood floors that were observed to be clean and free of stains, Flooring in designated Day care area has partial foam matts and partial carpet.

Bathroom was observed to be in proper working condition. Poisons, chemicals or other hazardous materials in bathroom's was observed by LPA to be made inaccessible with cabinet latch locks. Toilet was observed to be properly equipped with age-appropriate toileting equipment. Garbage bin was observed to have a tight-fitting lid in the bathroom. Applicant plans to utilize cots and cribs for napping children. LPAs observed two playpen and four cots for children to use during nap time. Applicant plans to provide sheets and blankets for older children. Applicant plans to wash once a week and wash as needed.

The outdoor area includes a large outdoor space, the outdoor space for Family Child Care Home use is only the enclosed area within the tan picket fence that also has fake grass. Backyard was observed to be fully fenced and enclosed with a high fence. As of now Applicant will only be using the enclosed outdoor area that is properly fenced. Applicant for now will keep the remaining outdoor area surrounding outside of the enclosed tan picket fence off limits. LPA did not observe any pools, spas or bodies of water on site.

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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Diana Alvarado
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2025
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: MACHADO, GISELLE
FACILITY NUMBER: 414005190
VISIT DATE: 01/14/2025
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Applicant was reminded baby walkers, bouncers, jumpers, and any other similar items are not to be used for children in care. The designated isolation area for sick children will be in the Living Room on the couch, separate from other children in care. LPA reminded applicant; children must be supervised at all times. Applicant plans to provide a food service such as breakfast, lunch and snack. If Applicant has infants under 6 months, Applicant will have parents provide formula and milk as needed.

LPA reminded applicant emergency disaster drills are to be conducted and documented at least once every six months. Applicant's CPR/First Aid training is current and will expire 08/2026. Applicant's Mandated Reporter training certification is also current and will expire 09/2026. 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 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 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 [or 12] 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 [or 14] children.

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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Diana Alvarado
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2025
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: MACHADO, GISELLE
FACILITY NUMBER: 414005190
VISIT DATE: 01/14/2025
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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.

On this date, 1/14/2025, 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.


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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Diana Alvarado
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2025
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: MACHADO, GISELLE
FACILITY NUMBER: 414005190
VISIT DATE: 01/14/2025
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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-carelicensing/ subscribe and select the Child Care option to receive email communication.


Prior to licensure, following is to be completed:
-Fingerprints, cleared and associated for all household residents.
-LIC 9149 if applicant would like to have up to 8 children
-Licensing board to be posted with all appropriate documents


Exit interview conducted and report was reviewed with the applicant, Giselle Machado

This Report was Translated in Spanish by LPA Alvarado
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Diana Alvarado
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2025
LIC809 (FAS) - (06/04)
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