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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002481
Report Date: 03/18/2025
Date Signed: 03/18/2025 04:00:38 PM

Document Has Been Signed on 03/18/2025 04:00 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:MARTINEZ, MARIA G.FACILITY NUMBER:
414002481
ADMINISTRATOR/
DIRECTOR:		MARTINEZ, MARIA G.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 580-1326
CITY:SOUTH SAN FRANCISCOSTATE: CAZIP CODE:
94080
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
03/18/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:31 PM
MET WITH:Maria G. MartinezTIME VISIT/
INSPECTION COMPLETED:
04:20 PM
NARRATIVE
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On 3/18/2025, at approximately 1:30PM, Licensing Program Analyst (LPA) Alvarado conducted an unannounced Plan of Correction (POC) visit at the facility. LPA met with Licensee, Maria G. Martinez, and explained the purpose of the visit. Present during the visit was Licensee and assistant supervising 8 children (3 Infants and 5 Preschool age children). At 2:10PM another assistant arrived at the facility. The facility is operating within staffing and ratio requirements on this day. All adults present are fingerprinted and associated.

During the Annual inspection visit on 2/25/2025, the Licensee received a Type A citation regarding Staffing Ratio and Capacity. Which posed an immediate risk to the health and safety of children. A Type A deficiency was issued, and a plan of correction was discussed with the licensee. Licensee submitted a schedule for the children in care to ensure that their schedules do not overlap to LPA Alvarado on 2/26/25.

During today's inspection the licensee has three infants present and five preschool age children and is within Staffing Ratio and Capacity limits on this day. LPA found that all children's files contained signed copies of LIC9224. The facility had posted the Notice of Site Visit and the report dated 2/25/2025 with the required postings in the entrance of the facility. During the Annual inspection on 2/25/2025 citations regarding Infant Safe Sleep were also issued and Technical Violations regarding maintaining documented emergency drills.

As of today 3/18/2025 three out of the four citations will be cleared. Deficiencies cited on 2/25/2025, were cleared today. The Letter of Deficiency Citation Cleared were provided to the Licensee.

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Ali ZebilaTELEPHONE: (650) 730-4140
Diana AlvaradoTELEPHONE: 650-266-8800
DATE: 03/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/18/2025
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: MARTINEZ, MARIA G.
FACILITY NUMBER: 414002481
VISIT DATE: 03/18/2025
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At 1:41 during the health and safety inspection along with the licensee, LPA observed four blankets in the cribs. The licensee removed the blankets immediately and safe sleep was discussed with the licensee.

At 2:50PM a child was picked up from the facility. At approximately 3:15 two more children (School Age) arrived at the facility. Currently 9 children Present (2 Infants 5 Preschool Age and 2 School Age). At 3:33PM 2 more children left the facility, with currently (2 Infants 3 Preschool Age and 2 School Age) in the facility. Per Licensee no more children were expected for the day.

See LIC 809-D for deficiencies being cited today also on 3/18/2025 under the California Code of Regulations, Title 22, Division 12, Chapter 1. Regarding Infant Safe Sleep.

A notice of site visit was provided and must be posted for 30 days.

Exit interview conducted and report was reviewed with Licensee, Maria G. Martinez.

Appeal rights were also provided to the licensee, Maria G. Martinez.

This report was translated in Spanish by LPA Alvarado.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 730-4140
LICENSING EVALUATOR NAME: Diana AlvaradoTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/18/2025 04:00 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: MARTINEZ, MARIA G.
FACILITY NUMBER: 414002481

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/18/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/21/2025
Section Cited
CCR
102425(b)

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(b) Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidenced by:
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Licesnee will submitt photos to LPA Alvarado by 3/21/2025 of the cribs being empty and LPA Alvarado will conduct a return visit to ensure that cribs are free from all loose articles and objects..
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Based on observation, interview, and record review, the licensee did not comply with the section cited above in four out of four objects, LPA Alvarado observed blankets inside the crib with children present. which posed a potential health, safety or personal rights risk to persons in care.
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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) 730-4140
Diana AlvaradoTELEPHONE: 650-266-8800

DATE: 03/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/18/2025

LIC809 (FAS) - (06/04)
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