410509747-3-20-2025-05-CC-LTMO-DEXVM7-20250320163304

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 410509747
Report Date: 03/20/2025
Date Signed: 03/20/2025 04:33:14 PM

Document Has Been Signed on 03/20/2025 04:33 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:	SAN CARLOS-BELMONT AFTER SCH.-BRITTAN ACRES SITE		FACILITY NUMBER:	410509747
ADMINISTRATOR/ DIRECTOR:	NICOLE CUCOLICHIO		FACILITY TYPE:	840
ADDRESS:	2000 BELLE AVENUE, ROOM F		TELEPHONE:	(650) 591-4599
CITY:	SAN CARLOS	STATE: CA	ZIP CODE:	94070
CAPACITY: 90	TOTAL ENROLLED CHILDREN: 97	CENSUS: 81	DATE:	03/20/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:15 PM
MET WITH:	Director, Nicole Cucolichio		TIME VISIT/ INSPECTION COMPLETED:	04:50 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On March 20th, 2025 at approximately 2:15PM, Licensing Program Analyst (LPA) Tapia-Mandujano conducted an unannounced annual inspection. LPA met with Director, Nicole Cucolichio and explained the purpose of the inspection. Present in the facility are Director and 7 staff supervising a total of 81 school age children. All adults working in the facility are fingerprint cleared and are associated. Facility is currently operating within teacher to child ratio on this date. Facility is on Brittan Acres Elementary School. Facility operates Monday-Friday from 7:30am-6pm following the School Year Calendar. Facility operates in Portable F and the outdoor playground behind the portable. LPA conducted a health and safety inspection and observed classroom to be clean and equipped with age-appropriate toys and materials. Storage for children's belongings are located inside the classroom. LPA observed facility has an installation of a fire alarm system throughout the building as well as a fully charged, fire extinguisher in the classroom. The building has a smoke and carbon monoxide detector installed as well as emergency kits with first aid materials and emergency contact information. Medication is stored appropriately, inaccessible to enrolled children and maintained with proper documentation. LPA observed that all children present were signed in by staff and will be signed out by authorized person. Facility has license documentation and information properly posted and available for review in the classroom. All poisons, cleaning solutions and hazardous materials are stored inaccessible to children in off limit areas or facility high shelves. Facility offers snacks. Menus are posted in the classroom. Facility offers water in each classroom that is refilled through water faucets that have been tested for lead. Water is available to children indoors and outdoors. Outdoor area appears to be clean and orderly. There are a variety of outdoor equipment that are in good working condition. Continued on Page 2…

Marie Rodriguez
Leslit Tapia-Mandujano
	DATE: 03/20/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2025

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 4

Document Has Been Signed on 03/20/2025 04:33 PM - It Cannot Be Edited

Created By: Leslit Tapia-Mandujano On 03/20/2025 at 04:08 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SAN CARLOS-BELMONT AFTER SCH.-BRITTAN ACRES SITE	FACILITY NUMBER: 410509747
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/20/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.16(a)(1)

Lead Testing

(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above as facility was tested passed the deadline which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/20/2025
	Plan of Correction
1 2 3 4	Facility was tested on May 18, 2023, the results were posted, and there were no exceedances. Deficiency was cleared as of today.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Marie Rodriguez

TELEPHONE:

LICENSING EVALUATOR NAME:

Leslit Tapia-Mandujano

TELEPHONE:

LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2025

LIC809 (FAS) - (06/04)

Page: 2 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: SAN CARLOS-BELMONT AFTER SCH.-BRITTAN ACRES SITE	FACILITY NUMBER: 410509747
	VISIT DATE: 03/20/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Page 2 Continued...

LPA reviewed facility records that included 5 children's records and 7 staff records. LPA observed children's and staff's records to be complete. At least one staff have an up-to-date CPR & First Aid certificate. All staff have up to date Mandated Reporter Certificate. Last emergency drill was conducted 02/2025. Emergency drills are conducted at least once every six months and are properly logged and documented.

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.

Facility was informed that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.

Director is aware that all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. LPA observed the completion certificate on file. LPA encourages the director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates.

Director was reminded that all adults 18 and over, 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 Child Care Center. 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.

Continued on Page 3...

SUPERVISOR'S NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2025

LIC809 (FAS) - (06/04)

Page: 3 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: SAN CARLOS-BELMONT AFTER SCH.-BRITTAN ACRES SITE	FACILITY NUMBER: 410509747
	VISIT DATE: 03/20/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Page 3 continued...

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).

LPAs verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP. Facility does not have any lead exceedances of 5.5ppb and is in compliance with the Written Directives.

Facility tested past the deadline, Type B deficiency was issued.

This facility provides Incidental Medical Services – IMS. LPAs reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. 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 are available at: https://www.ada.gov/resources/child-carecenters/.

Director 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.

Based on today's inspection, deficiencies were observed, according to California Title 22, Health and Safety Code of Regulations.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Director, Nicole Cucolichio.

SUPERVISOR'S NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2025

LIC809 (FAS) - (06/04)

Page: 4 of 4