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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005463
Report Date: 04/14/2025
Date Signed: 04/24/2025 10:38:35 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 04/24/2025 10:38 AM - 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:WILSON, MAYZA M.FACILITY NUMBER:
214005463
ADMINISTRATOR/
DIRECTOR:		WILSON, MAYZA M.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 410-7252
CITY:SAN RAFAELSTATE: CAZIP CODE:
94903
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 12DATE:
04/14/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Mayza WilsonTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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On 4/14/2025, Licensing Program Analyst (LPA) Jaclyn Naves made an unannounced required visit to the Family Childcare Home listed above. The LPA was granted entry by the Licensee, Mayza Wilson. The licensee was informed of the reason for today's visit by the LPA. Present in the home included the licensee, two assistants, nine preschool-aged children, and two infants. All individuals present in the home have fingerprint clearance to work or be in a family childcare home. The home operates within its capacity and in accordance with the required ratio of staff to children. Licensee hours of operation are Monday -Friday 8am-4pm.

Day-care Area(s): Living room/Play room, 1/2 Bathroom, Kitchen (only feeding area), Front yard and Office room (napping only)

Off Limit Area(s): Garage, Bedroom #1, Bedroom #2, Bedroom #3, and Bathroom. All off-limit areas are secured with a locked door or a safety gate. The licensee understands that off-limits areas may not be used for childcare during business hours.



LPA and the licensee carried out an inspection to identify any possible hazards to health and safety. Toys and equipment suitable for children of the proper age range are provided at the daycare. The LPA observed that the playground equipment and outdoor furnishings appeared to be in excellent condition. The building has sufficient lighting and ventilation and is free of any defects or conditions that put children at risk. The home provides a first aid kit that contains all necessary supplies for wound care and other injuries. The home has a smoke detector, a carbon monoxide detector, and a fire extinguisher. All garbage cans and power outlets have been appropriately covered. Products used for cleaning and washing, along with any
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Ali ZebilaTELEPHONE: (650) 266-8817
Jaclyn NavesTELEPHONE: (650) 266-8800
DATE: 04/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/18/2025
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 5
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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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: WILSON, MAYZA M.
FACILITY NUMBER: 214005463
VISIT DATE: 04/14/2025
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other materials that could potentially harm children, are kept safely out of their reach. During today's inspection, the LPA found no walkers, bouncers, or comparable objects. According to the licensee, no firearms or other weapons are on the premises. The LPA found that the home did not have any pools, spas, or other bodies of water of any kind. The LPA observed that the stairs inside the home were properly secured with a safety gate.

The LPA observed a designated area for children to sleep or rest quietly. The area includes sleeping mats, and cribs for each child, which are stored appropriately. The LPA observed two diaper changing stations in the home, which are clean and safe for the children to use. The LPA observed baby wipes and diapers were available for the children in care.

The LPA observed that all required documents were displayed in the home, such as the facility license, the Notification of Parental Rights, and the Earthquake Preparedness Checklist. Licensee stated she would be doing a disaster drill later on that day or the following morning as temperature that day was extremely warm.



The LPA reviewed the records of both the children and staff members. The LPA reviewed the five children's records and found that their files contain all necessary documents, including the Affidavit Regarding Liability Insurance, Immunization Record, Identification/Emergency Information, Consent for Emergency Medical Treatment, and Notification of Parents’ Rights. The LPA reviewed the sleeping records for children under two and confirmed that the data had been correctly recorded. Following a review of the staff records, the LPA found the licensee and the licensee’s two assistants possess a current certification in Pediatric First Aid/CPR. The licensee’s Pediatric First Aid/CPR certification expires on 6/2026. The LPA reminded the licensee that Mandated Reporter training must be completed every two years.

LPA reminded licensee the importance of sleep logs for all children under 24 months, licensee understood. Licensee has a separate isolation area for children should they become ill during care until parents arrive to pick up child. The 80/20 expectation was discussed with licensee.
Licensee will be updating pantry, under sink cabinets in kitchen with child proof locks. All cleaning detergents will be kept up high away from children until then.

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SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Jaclyn NavesTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2025
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: WILSON, MAYZA M.
FACILITY NUMBER: 214005463
VISIT DATE: 04/14/2025
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The licensee was reminded that all adults 18 and over living or working in the home, 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.

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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.



LPA discussed the safe sleep regulations with the licensee 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 the licensee 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.

The licensee was informed of the MyChildCarePlan.org website; 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.

During the exit interview, the licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

On 1/28/2025, 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

SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Jaclyn NavesTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2025
LIC809 (FAS) - (06/04)
Page: 5 of 5
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: WILSON, MAYZA M.
FACILITY NUMBER: 214005463
VISIT DATE: 04/14/2025
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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.

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.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

No deficiencies were issued today during LPA's visit.

A copy of today's report was given to Mayza Wilson.

A Notice of Site Visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Mayza Wilson.



Licensee signature obtained on paper 809 hand delivered on 4/24/25.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Jaclyn NavesTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2025
LIC809 (FAS) - (06/04)
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