414002584-3-27-2025-05-CC-JTSE-DF6VL5-20250327163122

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414002584
Report Date: 03/27/2025
Date Signed: 03/27/2025 04:31:54 PM

Document Has Been Signed on 03/27/2025 04:31 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:	LITTLE BLOOM CHILD DEVELOPMENT CENTER		FACILITY NUMBER:	414002584
ADMINISTRATOR/ DIRECTOR:	KYRA DE GUZMAN		FACILITY TYPE:	850
ADDRESS:	1911 ELKHORN COURT		TELEPHONE:	(650) 638-9300
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94403
CAPACITY: 73	TOTAL ENROLLED CHILDREN: 47	CENSUS: 0	DATE:	03/27/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:45 AM
MET WITH:	Director, Kyra de Guzman		TIME VISIT/ INSPECTION COMPLETED:	04:45 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 3/27/2025, at approximately 8:45AM, Licensing Program Analysts (LPAs) Jonathan Tse and Nicole Tran conducted an unannounced annual visit at the facility. LPAs met with Director Kyra de Guzman and explained the purpose of the visit. Present during the visit was Director and 14 staff members. There were no children present during the visit. This facility is a combination facility with an infant license (facility #414002585). LPAs and Director inspected the facility for any health or safety hazards. LPAs observed fully charged fire extinguishers that are at least size 2A10BC to be present. There are smoke detectors present in the facility. There is a fire alarm system running throughout the facility. LPAs did not observe carbon monoxide detectors to be present in the facility. LPAs advised that carbon monoxide detectors must be installed and present in the premises of a licensed child care center. Director stated that they understood. LPAs observed an inch long piece of rubber floor trim to be damaged. LPAs advised that it be replaced. Director stated that they understood. Emergency exits are clearly marked and labeled. Evacuation routes and plans are posted throughout the facility and accessible for review. Poisons, cleaning detergents, and other chemicals are stored inaccessible to children in care. Continued on Page Two

Ali Zebila	TELEPHONE: (650) 266-8817
Jonathan Tse	TELEPHONE: (650) 464-4927
	DATE: 03/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2025

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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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: LITTLE BLOOM CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 414002584
	VISIT DATE: 03/27/2025

NARRATIVE

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LPAs observed age-appropriate toys and learning materials present. Furniture is age-appropriate and free of rough or sharp edges. There are cubbies available for each child to store their belongings. Cubbies are labeled with each child’s name. The facility provides cots for napping children. Children bring bedding from home and take it back once a week for cleaning. Per Director, children provide lunch from home and the facility has extra meals available as needed. The facility provides snacks for children in care. Water bottles are brought from home and refilled at a non-contaminating fixture. Toilets and sinks were observed to be operational during the visit. Waste bins are fitted with tight-fitting lids.

LPAs observed the outdoor play area to be free of debris and other loose materials. Artificial turf is used as padding. The outdoor play area is enclosed by a fence that is at least four feet high. The facility has a waiver that allows for the use of the outdoor play area by a maximum of 35 children at a time. Per Director, the facility only has up to 30 preschool age children outside at a time. There are no swimming pools or other similar bodies of water present. There are no firearms or weapons stored in the facility.

LPAs reviewed nine staff files, nine children’s files, and facility records. There is at least one staff member with current Pediatric First Aid/CPR training. Staff qualifications are available for review. Children’s files were observed to be complete. The facility last conducted an emergency drill on 10/16/2024. Emergency drills are properly logged and documented. LPAs observed required postings to be posted and accessible for review upon entry to the facility.

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 representative 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 Three

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Jonathan Tse	TELEPHONE: (650) 464-4927
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2025

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: LITTLE BLOOM CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 414002584
	VISIT DATE: 03/27/2025

NARRATIVE

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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).

LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

This facility provides Incidental Medical Services – IMS. LPA 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-care-centers/.

Facility representative 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.

No deficiencies were cited during today’s visit on 3/27/2025. See LIC9102-TV for technical violation issued today regarding carbon monoxide detectors. See LIC9102-TA for technical assistance provided today regarding the floor trim. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the facility representative, Kyra de Guzman.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Jonathan Tse	TELEPHONE: (650) 464-4927
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2025

LIC809 (FAS) - (06/04)

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