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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004256
Report Date: 01/25/2023
Date Signed: 01/25/2023 12:17:53 PM


Document Has Been Signed on 01/25/2023 12:17 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
PENINSULA CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:MELAZZO, NEIDEMAR A.FACILITY NUMBER:
414004256
ADMINISTRATOR:MELAZZO, NEIDEMAR A.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 685-8270
CITY:SAN MATEOSTATE: CAZIP CODE:
94402
CAPACITY:14CENSUS: 12DATE:
01/25/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Neidemar Melazzo TIME COMPLETED:
12:30 PM
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On 1/25/2023 at 11:15AM., Licensing Program Analyst (LPA) Luis J. Gomez met with Licensee, Neidemar Melazzo. Purpose of the inspection was explained and was for an unannounced; Plan of Correction inspection. Present was the licensee and helper caring for 12 children (9 preschool age, 3 infant age). Adults have criminal record clearance on file. LPA inspected facility for health and safety hazards.

During today’s inspection, LPA performed record review, observations and interviews.

Based on observations, licensee is operating within limit stated on license with three infants (12 children) in care. Updated schedule and children roster has been submitted to the department.

Notice of site was observed posted in entry way. LPA reminded licensee to have all authorized representatives sign required, LIC9224 ‘Notice of A type Deficiency’.

Deficiency issued on 12/22/2022, has been cleared and ‘Cleared Plan of Correction Letter’ was provided.

Based on today's inspection, no deficiencies were observed in the areas evaluated according to Title 22 Division 12 Chapter 3, Ca. Code of Regulations. Exit interview was discussed with Licensee, Neidemar Melazzo, and signature of this form acknowledges receipt of these documents.

This report must be available in the facility for public review. Notice was provided and must remain posted for 30 days. Licensee was advised for additional questions to call CCL Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 01/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/25/2023
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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