214002724-8-21-2025-05-CC-AMEN-DKRUBE-20250821152611

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 214002724
Report Date: 08/21/2025
Date Signed: 08/21/2025 03:27:43 PM

Document Has Been Signed on 08/21/2025 03:27 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:	LE PETIT JARDIN		FACILITY NUMBER:	214002724
ADMINISTRATOR/ DIRECTOR:	AMBER JEAN SMITH		FACILITY TYPE:	860
ADDRESS:	1 ST. VINCENT DRIVE		TELEPHONE:	(415) 377-8541
CITY:	SAN RAFAEL	STATE: CA	ZIP CODE:	94901
CAPACITY: 45	TOTAL ENROLLED CHILDREN: 45	CENSUS: 0	DATE:	08/21/2025
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:00 AM
MET WITH:	Amber Smith		TIME VISIT/ INSPECTION COMPLETED:	03:30 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 08/21/2025, Licensing Program Analysts (LPAs) Andrea Medlin and Jaelyn Agbayani met with applicant representative, Amber Smith. The purpose of the visit was an announced pre-licensing inspection at the facility to ensure the health, safety, and personal rights are required by Title 22 and Health and Safety Regulations governing California Child Care Centers will be met. This is an application for 45 children: 15 toddlers (ages 18-36 months old) in toddler classrooms 4, 5, and the library, and 30 preschool children (ages 2- 5 years old) in classrooms 1, 2, 3, and the kitchen as needed. The childcare center will operate Monday - Friday 8:00AM-5:00PM. The fire inspection was conducted and approved on 2/26/2025 by Marin County Fire Department. There were no children present during this inspection. LPAs toured and measured the on-limits areas and classrooms located at the facility. The facility has a total of 5 classrooms and one library. In addition to activity space, the facility also has a kitchen that children will use for cooking activities with supervision. Toddler Classroom measurements are: The Indoor total measurements contain a total of 706.87 square feet, which will accommodate applicant's request for 15 toddlers. Preschool Classroom measurements are: The Indoor total measurements contain a total of 1142.62 square feet, which will accommodate applicant's request for 30 preschool children. Toddler Outdoor Play measurements are: Outdoor total measurements contain a total of 4814.08 square feet, which will accommodate applicant’s request for 15 toddlers. (Continued on next page LIC-809-C)

NAME OF LICENSING PROGRAM MANAGER: Deborah Lowe
NAME OF LICENSING PROGRAM ANALYST: Andrea Medlin
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2025

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 5

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 5

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: LE PETIT JARDIN	FACILITY NUMBER: 214002724
	VISIT DATE: 08/21/2025

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
Preschool Outdoor measurements are:
The outdoor total measurements contain a total of 8991.84 square feet, which will accommodate applicant's request for 30 preschool children.

LPAs observed all classrooms to be clean, safe, sanitary, and in good repair. A comfortable temperature for children shall be maintained at all times. Furniture and equipment were observed to be maintained in good condition, free of sharp, loose, or pointed parts. All materials and surfaces accessible to children including toys, shall be free of toxic substances. All play equipment and materials used by children were observed to be age-appropriate. LPAs observed a small portable AC unit in preschool classroom. LPAs observed a fully charged fire extinguisher, carbon monoxide, and smoke detectors in the facility. Children will have access to a total of 4 sinks, 4 toilets, and 1 changing table. LPAs observed cubbies at the entrance of both the toddler and preschool entrance ways. Staff have separate bathroom that can be utilized by sick children if needed. Sick children will be isolated in the office area of the facility. LPAs observed that items that may pose a danger to children were stored in a locked boiler room inaccessible to children. LPAs observed containers with tight-fitting lids for the disposal of solid waste. LPAs advised that applicant maintains first-aid supplies in a location accessible to staff but inaccessible to children.

All outdoor and indoor passageways and other areas of potential hazard were observed to be free of obstruction. The child care center was observed to be clean, safe, sanitary and in good repair. The facility is equipped with central heating to provide and maintain a comfortable temperature for children at all times. Per applicant representative, the facility will not be providing snacks or lunch to children. Parents will provide snack and lunch to children. Applicant was advised that full-day programs shall ensure that each child has a lunch and children shall be free to drink as they wish. Drinking water is readily available via filtered water dispenser. LPAs observed a kitchen/food preparation area kept clean and free of litter and rubbish; applicant was advised that measures shall be taken to keep kitchen areas free of rodents and other vermin.

Drinking water from a non-contaminating fixture or container shall be readily available both indoors and in the outdoor activity area. LPAs advised per Health and Safety Code 1597.16(a)(1) Lead Testing and PIN-21-21-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 drinking water for lead contamination between January 1, 2020 and January 1, 2023, and then every 5 years after the date of the first test. Per Written Directive 100700(c)(1) Written Directives for Lead Testing (1) For a license issued on or after July 1, 2022, initial testing results shall be received and posted within 180 days of licensure.
(Continued on next page 809-C)

NAME OF LICENSING PROGRAM MANAGER: Deborah Lowe
NAME OF LICENSING PROGRAM ANALYST: Andrea Medlin
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2025

LIC809 (FAS) - (06/04)

Page: 3 of 5

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: LE PETIT JARDIN	FACILITY NUMBER: 214002724
	VISIT DATE: 08/21/2025

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
Per Written Directive 100700(c)(1) for Lead Testing (1). For a license issued on or after July 1, 2022, initial testing results shall be received and posted within 180 days of licensure.

LPAs advised applicant of licensing requirement of 35 square feet per child for indoor space; one toilet and hand washing fixture requirement for every 15 children.

Outdoor area for toddler and preschool children were free of hazards including, holes, broken glass dry grasses, and other debris that pose a fire hazard. Shade was provided by trees and outdoor overhead structure. The areas around and under high climbing equipment had cushioned with material (woodchips and turf) that absorbs falls. The playground is enclosed by a fence at least four feet high to protect children and to to keep them in the outdoor activity area. Any construction or equipment that could pose a hazard in the outdoor activity area shall be made inaccessible to children in care. LPA observed no bodies of water.

LPA observed the following postings in a prominent, publicly accessible location in the center. LIC 613A(9/96), PUB 393 (8/02), Child Care Center Notification of Parents' Rights and LIC 610 Disaster Plan. The license shall be posted when received; applicant reminded of the requirements to ensure license number is included in all advertisements in accordance with Health and Safety Code Section 1596.861.

Applicant was reminded that all adults 18 and over responsible for administration, 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 of5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if in violation.

LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep, as an additional resource. LPA also informed applicant of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at: https://www.cpsc.gov/, and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.
Report continued LIC 809C

NAME OF LICENSING PROGRAM MANAGER: Deborah Lowe
NAME OF LICENSING PROGRAM ANALYST: Andrea Medlin
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2025

LIC809 (FAS) - (06/04)

Page: 4 of 5

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: LE PETIT JARDIN	FACILITY NUMBER: 214002724
	VISIT DATE: 08/21/2025

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
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.

Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helpsfamilies obtain child care by connecting them to child care providers and Resource and ReferralAgencies (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 News letters and other important information communication platforms.To receive important licensed related information to licensed facilities, visit the CCLD ImportantInformation website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

The following corrections are needed before licensure will be considered. Corrections are due by September 22, 2025:

Final review of application packet by LPM
Baby gate at bottom of stairwell of toddler play yard.
Changing table must have at least 3" raised sides
Fence/gate installation to enclose prechool play yard from church access
Gate installation for kitchen to make inaccessible when not in use
Submission of Lead Testing Waiver Request.

Final licensure approval will be determined by review by the Centralized Application Bureau (CAB) Licensing Program Manager.

Exit interview conducted and reviewed with facility representative, Amber Smith, and a copy of this report must be made available for public review upon request.

NAME OF LICENSING PROGRAM MANAGER: Deborah Lowe
NAME OF LICENSING PROGRAM ANALYST: Andrea Medlin
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2025

LIC809 (FAS) - (06/04)

Page: 5 of 5