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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 210102877
Report Date: 05/09/2025
Date Signed: 05/09/2025 02:50:03 PM

Document Has Been Signed on 05/09/2025 02:50 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:NOVATO PARENTS NURSERY SCHOOL, INCFACILITY NUMBER:
210102877
ADMINISTRATOR/
DIRECTOR:		BURNS, ALISONFACILITY TYPE:
850
ADDRESS:1473 SOUTH NOVATO BOULEVARDTELEPHONE:
(415) 897-4498
CITY:NOVATOSTATE: CAZIP CODE:
94947
CAPACITY: 26TOTAL ENROLLED CHILDREN: 26CENSUS: 0DATE:
05/09/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:35 PM
MET WITH:Director Alison Claire BurnsTIME VISIT/
INSPECTION COMPLETED:
03:10 PM
NARRATIVE
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On 5/9/2025, at approximately 1:20PM, Licensing Program Analysts (LPAs) Tran and Garcia conducted an unannounced case management visit regarding a self-reported incident. LPAs met with Director, Alison Clare Burns, and explained the purpose of the visit. Present during the visit was one staff and zero children. The facility closes at 1:00PM on Fridays.

The facility reported an incident that occurred on 4/17/2025 involving a child hiding in a play structure and being unaccounted for during a transition period. Per Director, the child was not in distress when found.

LPAs toured the outdoor play area with the Director. There is a large area separated by a fence to create two zones. Per Director, each zone generally has one teacher and two parents supervising at all times. There is also a clipboard in each area so adults can verify which kids are present the day of.

After the incident, the Director has implemented new protocols such as only having teachers facilitate transition periods and having more ratio/counting check-ins amongst them. The Director also met with parents and reminded them the importance of active and visual supervision to prevent similar future incidents.
Based on interview and information gathered during the visit, it is confirmed that there was a lack of supervision on the day of the incident.

Type B deficiency will be issued for lack of supervision.

A notice of site visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with Director, Alison Clare Burns.
Ali ZebilaTELEPHONE: (650) 464-0491
Nicole TranTELEPHONE: 650-266-8800
DATE: 05/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/09/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 05/09/2025 02:50 PM - It Cannot Be Edited

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: NOVATO PARENTS NURSERY SCHOOL, INC
FACILITY NUMBER: 210102877

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/16/2025
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary...(1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified... Supervision shall include visual observation.
This requirement is not met as evidenced by:
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Director explained that a meeting regarding active supervision was held with parents and teachers. The contents of the meeting involved limiting transitions between the two play areas, doing more counts amongst the adults, and only having teachers handle transitions.
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Based on the incident report and interview, the facility did not ensure to provide supervision at all times, which poses a potential Health, Safety, and Personal Rights risk to persons in care.
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Director will provide a copy of the meeting agenda with the staff and parents' signatures acknowledging the changes made by 5/16/2025.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Ali ZebilaTELEPHONE: (650) 464-0491
Nicole TranTELEPHONE: 650-266-8800

DATE: 05/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/09/2025

LIC809 (FAS) - (06/04)
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