<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 213004686
Report Date: 04/14/2026
Date Signed: 04/14/2026 04:56:39 PM

Document Has Been Signed on 04/14/2026 04:56 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 GERONIMO VALLEY COMMUNITY CENTER CHILD CAREFACILITY NUMBER:
213004686
ADMINISTRATOR/
DIRECTOR:		NICOLE RAMIREZFACILITY TYPE:
840
ADDRESS:6350 SIR FRANCIS DRAKE BLVD.TELEPHONE:
(415) 488-8888
CITY:SAN GERONIMOSTATE: CAZIP CODE:
94963
CAPACITY: 52TOTAL ENROLLED CHILDREN: 20CENSUS: 16DATE:
04/14/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:10 PM
MET WITH:Julie Arian (Young) and Lori RamirezTIME VISIT/
INSPECTION COMPLETED:
05:10 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 April 14, 2026, Licensing Program Analyst (LPA) Van conducted an unannounced annual inspection of the school-age after-school program and met with assistant director Julie Arian. The purpose of the inspection was explained, and the assistant director granted LPA access to the facility. The program currently operates in Classroom #7 and the multipurpose room.

The center operates on Mondays from 12:00 p.m. to 5:30 p.m. Staff pick up children directly from their elementary classrooms and escort them to the program. Upon arrival, staff use the MyRec electronic sign-in/sign-out system and conduct a headcount to ensure all children are accounted for. At the time of inspection, the assistant director and two teachers were supervising 16 school-aged children. All staff present were verified through the CDSS Guardian Background Check system and were confirmed to have eligible criminal record clearances.

LPA and the assistant director began the walkthrough in Classroom #7. The room contained appropriate games, books, and learning materials that were clean, organized, and in good condition. Adequate ventilation and lighting were observed throughout. A centralized smoke and carbon monoxide detector was present, and a fully charged fire extinguisher was accessible. First aid supplies were available in the classroom and in the office. The assistant director reported that no children currently require medication; if medications are provided in the future, they will be stored in a locked cabinet inaccessible to children.
Continued on page 2.
NAME OF LICENSING PROGRAM MANAGER: Garfield Leung
NAME OF LICENSING PROGRAM ANALYST: Brendon Van
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/14/2026
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 6
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)
Page: 2 of 6
Document Has Been Signed on 04/14/2026 04:56 PM - It Cannot Be Edited


Created By: Brendon Van On 04/14/2026 at 03:32 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 GERONIMO VALLEY COMMUNITY CENTER CHILD CARE
FACILITY NUMBER: 213004686

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/14/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on the record review, LPA observed that two of the three teachers did not have complete immunization records on file. Missing documentation included proof of immunization for measles, mumps, and rubella (MMR). The lack of complete immunization records poses a potential health risk to children in care.
POC Due Date: 05/05/2026
Plan of Correction
1
2
3
4
The director shall obtain and maintain complete immunization documentation for the affected staff, including proof of MMR immunization or immunity, and submit proof of correction to LPA by the due date.
Type B
Section Cited
CCR
101216(f)
Personnel Requirements
(f) At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review and staff interviews, LPA observed that none of the three staff members present had a valid Pediatric First Aid and CPR certification on file or available for review. The absence of staff with valid Pediatric First Aid and CPR certification poses a potential health and safety risk to children in care.
POC Due Date: 05/05/2026
Plan of Correction
1
2
3
4
The director shall ensure that at least one staff member present at the center has proof of valid and current Pediatric First Aid and CPR certification at all times when children are in care. Proof of completed certification for the three staff members shall be submitted to LPA by the due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Garfield Leung
NAME OF LICENSING PROGRAM MANAGER:
Brendon Van
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/14/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/14/2026


LIC809 (FAS) - (06/04)
Page: 3 of 6
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 GERONIMO VALLEY COMMUNITY CENTER CHILD CARE
FACILITY NUMBER: 213004686
VISIT DATE: 04/14/2026
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.
The multipurpose room, also approved for program use, was observed to be clean, orderly, and equipped with appropriate materials for school-age activities. Children access this room by crossing a small creek via a bridge, which was observed to be safe and stable.

All bathrooms were in working condition, clean, and sanitary. Solid waste bins had tight-fitting lids. Cleaning solutions, chemicals, and other hazardous items were stored out of children’s reach.

Food items brought from home were properly labeled and stored to prevent contamination. The assistant director stated that the facility provides PM snacks prepared and served onsite. Lunches are not offered because this is an after-school program. The kitchen sink serves as the main source of drinking water, and water is filtered through Brita pitchers refilled from the faucet. Children also bring water bottles from home. Water was available both indoors and outdoors, and in emergency bags. All foods served are nut-free, and the food preparation area was free of litter and maintained in a sanitary condition.

The outdoor playground was fully fenced and in good repair. Age-appropriate play structures were free of hazards, and shaded areas were available for rest. A garden area was present, along with a variety of riding toys and carts. Storage sheds and bins were available for outdoor equipment when not in use. No pools or spas were located on the premises.

LPA reviewed both children’s and staff files. Children’s records were complete and included all required information, such as the names, addresses, and phone numbers of authorized representatives. Each child’s file also contained signed Personal Rights and Parents’ Rights forms. Staff files showed that all individuals requiring background checks had obtained clearances for criminal records and the Child Abuse Index, or held exemptions. None of the three staff members present had current pediatric first aid/CPR certification. LPA noted that some staff did not have up-to-date mandated reporter training certificates, and two of the three staff files were missing documentation of measles and influenza vaccinations. See LIC 809D for deficiencies cited today.
Continued on page 3.
NAME OF LICENSING PROGRAM MANAGER: Garfield Leung
NAME OF LICENSING PROGRAM ANALYST: Brendon Van
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2026
LIC809 (FAS) - (06/04)
Page: 4 of 6
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 GERONIMO VALLEY COMMUNITY CENTER CHILD CARE
FACILITY NUMBER: 213004686
VISIT DATE: 04/14/2026
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.
LPA reminded the assistant director to ensure all required postings are displayed, including Waivers, Notification of Parents’ Rights, and Notification of Personal Rights. A list of required postings was provided to the assistant director.

The Director stated that monthly fire and earthquake drills were completed on June 4, 2025. LPA reminded the assistant director that fire and earthquake drills must be conducted at least once every six months.

The Assistant 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

The Assistant Director was informed about Mandated Reporter training AB 1207. The Mandated Reporter AB 1207 training must be completed every two years by the Licensee and for all staff hired. Training can be taken online at www.mandaterreporterca.com. Also, the Assistant Director was reminded of Pesticide training. Information on the DPR website at: www.cdpr.ca.gov/shoolipm/childcare
Continued on page 4.
NAME OF LICENSING PROGRAM MANAGER: Garfield Leung
NAME OF LICENSING PROGRAM ANALYST: Brendon Van
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2026
LIC809 (FAS) - (06/04)
Page: 5 of 6
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 GERONIMO VALLEY COMMUNITY CENTER CHILD CARE
FACILITY NUMBER: 213004686
VISIT DATE: 04/14/2026
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 4.
The Assistant Director was informed of the MyChildCarePlan.org website, a consumer education website that helps families obtain child care by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

CCC COMPLETED TESTING AND NO LEAD EXCEEDANCES.

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

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 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).

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

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

An exit interview was conducted, and the report and appeal rights were reviewed with the Assistant Director, Julie Arian.
NAME OF LICENSING PROGRAM MANAGER: Garfield Leung
NAME OF LICENSING PROGRAM ANALYST: Brendon Van
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2026
LIC809 (FAS) - (06/04)
Page: 6 of 6