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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075700626
Report Date: 07/29/2026
Date Signed: 07/29/2026 12:17:28 PM

Document Has Been Signed on 07/29/2026 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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:SRVSACCA-KIDS COUNTRY@BELLA VISTAFACILITY NUMBER:
075700626
ADMINISTRATOR/
DIRECTOR:		BRIDGETT ELLIOTTFACILITY TYPE:
860
ADDRESS:1050 TRUMPET VINE LANETELEPHONE:
(925) 866-9419
CITY:SAN RAMON, CASTATE: CAZIP CODE:
94582
CAPACITY: 133TOTAL ENROLLED CHILDREN: 133CENSUS: 0DATE:
07/29/2026
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Applicant Ann TanciocoTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On 7/29/2026 at 10 am, Licensing Program Analyst (LPA) Manel Estoesta conducted a pre-licensing inspection. LPA met with the applicant, Ann Tancioco. The applicant requested a school age component for 133 school age children, from Transitional Kindergarten to 12 years old. The program will operate Monday through Friday from 6:30 am to 6:30 pm.

The fire clearance was granted and received on 7/22/2026. The facility will provide children’s lunches and snacks. The facility is located on the functioning schoolsite / campus of Bella Vista Elementary School.

LPA reviewed with applicant the LIC 311A, Records to be Maintained at the facility, for child’s records, personnel records, administrative records, and documents to be posted.

INDOOR ACTIVITY SPACE:

There are 2 classrooms as DC101 and DC102. The fire clearance conditions for the 2 classrooms are for 100 students. The facility will be also utilizing the school’s Library, which will accommodate 33 children as per the fire clearance, and the school’s Multi-Purpose Room (MPR).

LPA observed an adequate number of children's activity equipment, toys, tables, chairs and cubbies. There is a first aid kit located in one of the classrooms. Medications will be stored in the medication box in the closet located next to the first aid kit. LPA observed cleaning disinfectants are appropriately stored and inaccessible to children. The applicant stated there are no poisons or firearms on the premises. Drinking water would be sourced from the classroom’s faucet and will be using water pitchers and cups that are available during indoor and outdoor activities.

Jason Jang
Manel Estoesta
DATE: 07/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/29/2026
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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: SRVSACCA-KIDS COUNTRY@BELLA VISTA
FACILITY NUMBER: 075700626
VISIT DATE: 07/29/2026
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. LPA observed a functional carbon monoxide detector, fire extinguishers, smoke alarms and sprinkler system in the classrooms. LPA observed six sinks and 4 toilets in the children’s bathroom in the classroom. There is a separate private restroom for the staff members. Children who become ill during the day will be isolated in the office and will use the staff restroom, if necessary.

OUTDOOR ACTIVITY SPACE:

The facility will be utilizing the school's outdoor play areas, the two areas are located at school's kindergartens outdoor space and one area located on the school's main outdoor space. The outdoor play areas are fenced that is at least four feet tall. LPA observed one play structure on one of the outdoor play areas, that is for the ages 2-5 years old. LPA observed enough equipment and toys. There are no bodies of water on the premises. There are shaded areas for the children to use.

LPA discussed the following: 100% supervision is always required; personal rights; inspection authority; reporting requirements; staff to children’s ratios and capacity; staff qualifications; and maintaining buildings and grounds. LPA discussed with the applicant that any changes that may occur regarding the director or an employee acting in the director's absence must be reported to the department within 10 working days.

The applicant was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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.

The applicant has an active centralized criminal record association for the other locations and will send a request for this site to be part of that waiver. LPA will reach out to the LPA’s management for approval.

NAME OF LICENSING PROGRAM MANAGER: Jason Jang
NAME OF LICENSING PROGRAM ANALYST: Manel Estoesta
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2026
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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: SRVSACCA-KIDS COUNTRY@BELLA VISTA
FACILITY NUMBER: 075700626
VISIT DATE: 07/29/2026
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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 as specified in Health and Safety Code section 1597.16. For childcare 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.) The facility was constructed after January 1, 2010 and exempt from this requirement.

The applicant was informed of the MyChildCarePlan.org site, 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.

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/communitycare-licensing/subscribe and select the Child Care option to receive email communication. 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.

Exit interview conducted and report was reviewed with the applicant, Ann Tancioco.

The following items are required before a license will be issued:

1. Pending Licensing Program Managers (LPMs) review and approval of Shared Outdoor Activity Space and Centralized Centralized Criminal Record Association Waiver.

NAME OF LICENSING PROGRAM MANAGER: Jason Jang
NAME OF LICENSING PROGRAM ANALYST: Manel Estoesta
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2026
LIC809 (FAS) - (06/04)
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