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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214002739
Report Date: 09/04/2025
Date Signed: 09/04/2025 12:30:12 PM

Document Has Been Signed on 09/04/2025 12:30 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:REYES VASQUEZ, ELMA E.FACILITY NUMBER:
214002739
ADMINISTRATOR/
DIRECTOR:		REYES VASQUEZ, ELMA E.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 580-5887
CITY:NOVATOSTATE: CAZIP CODE:
94947
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
09/04/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:35 AM
MET WITH:Elma Reyes VasquezTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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On 9/4/2025 at 9:35AM., Licensing Program Analyst (LPA), Luis Gomez met with Licensee, Elma Reyes Vasquez. The purpose of today’s inspection was explained and was for an Announced; prelicensing inspection for change of facility location. Licensee’s previous license #214005660. Present was the licensee and no children. The home is a 2 bedroom, 2 bathroom, 2 level townhouse. Per licensee, the days and hours of operations are: Monday- Sunday, 6:30AM- 5:30PM. The area of the home designated for childcare are: Lower Level: Livingroom #1 (Playroom 1), Livingroom #2 (Feeding/ Activity Room), Kitchen, Bathroom #1/ Laundry Area, and Outside Patio. The areas designated as off-limit are: Upper Level: Bedrooom #1, Bedroom #2, Bathroom #2, and staircase. LPA inspected home inside and outside for health and safety hazards.

At 9:55AM., the following was observed: Home was clean, neat, with a variety of age-appropriate playthings available for the children. The floor and ground surfaces were clear of any obstructions or fall hazards. The childcare’s furniture, tables/ chairs, and accessible materials were in good repair. License has a diaper changing table, available.

Furniture was scaled to the proper size. LPA observed infant tables, with several chairs for feeding infant-age children. The available bathroom (bathroom #1) was observed clean with fixtures in operating condition.

The license has an accessible kitchen area, with safety locks installed on several cabinets and draws. Per license, sharp and hazardous objects have been stored out-of-reach. The detergents, cleaning compounds, and items which can pose a hazard have been made inaccessible. Home has ventilation, lighting, and was comfortable temperature.

For nap services, LPA observed plan pens and stackable cots. Play pens has tight -fitted mattress and sheets. The home has a functioning telephone service (cell phone), smoke/ carbon monoxide combination detector; and fully charged fire extinguisher (2A:10BC). The fire -pull alarm in the playroom.

LPA inspected the Outside Patio. Area was enclosed with turf padding, and playthings inspected were in good repair. Per licensee, The HOA, community pool located near the street, which will not be used. (REFER TO 809C, FOR CONT.)

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Luis Gomez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/04/2025
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: REYES VASQUEZ, ELMA E.
FACILITY NUMBER: 214002739
VISIT DATE: 09/04/2025
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(PAGE 2)
LPA and licensee reviewed the ‘Records to Keep in Your Family Childcare Home’ (LIC311D), which includes the Children's Forms/ Records; Facility Forms; and Information to be Posted.

Licensee’s ‘Cardiopulmonary Resuscitation / First Aid certification was current, expiring on: 1/2027.
Licensee’s proof of completed Mandated Reporter Training (AB1207) was current, expiring on: 10/2026.

The required forms have been posted and include the Emergency Disaster Plan (LIC610A); Notice of Parents Rights (PUB394); and Earthquake Preparedness Checklist.

Per licensee, isolation of an ill child will be in playroom (living room #1). FCC has a pet dog on-site. Per licensee, pet is vaccinated.

Licensee was informed that the Department must be notified prior to the use of designated off-limits areas. LPA and the applicant discussed licensing regulations and required ratio for requested the capacity requirements. Any children under 10 years of age will be counted in the capacity. Licensee was advised that all food containers brought from home must be properly stored and labeled. Licensee understands the required emergency disaster drills are to be conducted and documented every six months. Licensee understands that the use baby walkers, bouncers, jumpers or any similar items are not to be used for children in care. All smoking is prohibited inside a Family Childcare Home.

Licensee was informed that as of September 1, 2016, a person may not be employed or volunteer at a childcare facility, unless he or she has been immunized for influenza, pertussis and measles or qualifies for an exemption pursuant to Health and Safety Code 1596.7995 and 1597.662.

Licensee was informed that all adults 18 years and over, living or working in the home, including employees and volunteers, must obtain criminal clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/ day up to $500.00 maximum per day/ per person will be assessed if this regulation is violated. (REFER TO 809C, FOR CONT.)

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Luis Gomez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: REYES VASQUEZ, ELMA E.
FACILITY NUMBER: 214002739
VISIT DATE: 09/04/2025
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(Page 3)
LPA discussed the safe sleep regulations with licensee and discussed Child Care Licensing Safe Sleep Web page at:https://www.cdss.ca.gov/inforesource/child-care-licesning/public-information-and-resources/safe-sleep as an additional resource. LPA informed licensee of the importance of checking for recalled infant devices on United States consumer Product Safety Commission (CPSC) website at http://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed with licensee. For IMS information, please see PIN 20-02-CCP. When an IMS is provided, a plan for 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- 0382 (TTY) and link to publications: Commonly asked questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

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 communication platform.

To receive important licensed- related information to licensed facilities, visit the CCLD important information website at https://www.cdss.ca.gov/infosource/community-care-licensing/subscribe and select the child care option to receive email communication.

Prior to recommendation for approval of childcare licensure Change of Location, (Large Capacity), Licensee will complete the following:


-Fire Clearance Approval (STD850)
-Install soft padding on exposed corner in Living Room #1
-Install functioning lamp in Living Room #1
-Anchor movable shelving near fireplace and kitchen
-Anchor shading umbrella in patio area
-Barricade stairs to prevent access to the upper level
-Make washer and dryer in bathroom #1 inaccessible
-Submit the Earthquake Preparedness Checklist (LIC9148)

Exit interview and report was conducted with Licensee and copy of this report was provided. This report will be kept in the facility file and made available for public review upon request. Desk Duty is available Monday- Friday between 8:00AM – 5:00PM at (650) 266 -8800.
NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Luis Gomez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025
LIC809 (FAS) - (06/04)
Page: 4 of 4