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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414005198
Report Date: 01/24/2025
Date Signed: 01/24/2025 12:35:34 PM

Document Has Been Signed on 01/24/2025 12:35 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:GIRON MATAMOROS, EVELYN F., CABRERA CONTRERAS, EVEFACILITY NUMBER:
414005198
ADMINISTRATOR/
DIRECTOR:		GIRON MATAMOROS, EVELYNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 331-0507
CITY:EAST PALO ALTOSTATE: CAZIP CODE:
94303
CAPACITY: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 0DATE:
01/24/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Applicants, Evelyn F. Giron Matamoros and Evelyn X. Cabrera ContrerasTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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On January 24th, 2025 at approximately 9:30am, Licensing Program Analyst (LPA), Tapia-Mandujano conducted a scheduled Pre-Licensing inspection this day and met with Applicant, Evelyn F. Giron Matamoros and Evelyn X. Cabrera Contreras. Applicants have relocated from previously licensed facilities: Evelyn F.- 414004644 and Evelyn X.- 414004298. Applicants has applied for a Large Family Child Care License. Fire Clearance was received by Menlo Park Fire Department on January 21st, 2025. Present in the home today were applicants. LPA and applicants inspected entire home for Health and Safety Hazards.

Applicant rents a one-story level house with three bedroom, two bathroom home with detached garage. Applicants live with four other adults, and two minor children. The hours of operations will be from Monday-Friday from 7:30am-5:30pm. The ages that applicants plan to care for are ages 3 months to 5 years old. All adults living in the home have obtained fingerprint clearance and are associated.

Daycare areas are: Living Room, Dining Room, Bathroom #2, Front portion of backyard. OFF limit areas are: Bedroom #1-#3, Kitchen, Basement, Detached Garage, Side yards, Back portion of the Backyard, and Driveway/Front Yard. All off-limit areas are properly barricaded, including all closets.

LPA observed the following: Daycare Area is clean with sufficient light and ventilation. All furniture inspected is in good repair. The applicants have a fully stocked First Aid kit. The home has no pools or bodies of water. Per applicants, there are no pets in the home. Home does have a fireplace that is properly barricaded. Open face heaters are properly barricaded. Per applicants, there are no guns or weapons in the home. The home has age-appropriate equipment available for children in care. Applicant was reminded baby walkers, bouncers, jumpers, and any other similar items are to not be used for children in care. Discipline policy was discussed. Isolation area for sick child will be in the main entrance by the dining room.

Applicants acknowledges they will conduct an emergency drill at least once every six months and log drills. Both applicant’s CPR & First Aid certificate will expire on 06/2025 and Mandated Reporter Training Certificate will expire on 10/2025 for Evelyn F. and 01/2027 for Evelyn X.

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SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE: DATE: 01/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/24/2025
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 3
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: GIRON MATAMOROS, EVELYN F., CABRERA CONTRERAS, EVE
FACILITY NUMBER: 414005198
VISIT DATE: 01/24/2025
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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.

APPLICANT WILL WAIT UNTIL FACILITY OPENS TO DETERMINE IMS NEEDS:
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. During today's inspection, LPA received pending documentation. LPA received and reviewed LIC 279 and LIC 610A.

LPA discussed the safe sleep regulations with applicants and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/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.

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SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2025
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: GIRON MATAMOROS, EVELYN F., CABRERA CONTRERAS, EVE
FACILITY NUMBER: 414005198
VISIT DATE: 01/24/2025
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On this date, 1/22/2025, 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 childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

LPA will recommend approval of Large Family Child Care Home License as of today, January 24th, 2025.

Exit interview conducted and report was reviewed and translated into Spanish by LPA Tapia-Mandujano with the applicant, Evelyn F. Giron Matamoros and Evelyn X. Cabrera Contreras.

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.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2025
LIC809 (FAS) - (06/04)
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