214002750-12-12-2025-05-CC-JNAS-DPASQG-20251212130443

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 214002750
Report Date: 12/12/2025
Date Signed: 12/12/2025 01:05:01 PM

Document Has Been Signed on 12/12/2025 01:05 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:	SILVEIRA, JESSICA & SILVEIRA, PATRICIA		FACILITY NUMBER:	214002750
ADMINISTRATOR/ DIRECTOR:	SILVEIRA, JESSICA & SILVEI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 301-0110
CITY:	SAN RAFAEL	STATE: CA	ZIP CODE:	94903
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	12/12/2025
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:20 AM
MET WITH:	Jessica Silveira		TIME VISIT/ INSPECTION COMPLETED:	01:20 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 December 12, 2025, Licensing Program Analyst (LPA) Naves, conducted a scheduled relocation pre-licensing visit. LPA met with applicant, Jessica Silveira, and explained the purpose of the visit. Applicants submitted a relocation application to our department in November 2025. A short time later co- applicant Patricia Silveira arrived. Applicants are in the process of relocating from Facility #214005464 to this location. Present during the visit were the two applicants and their 2 service dogs which are both vaccinated according to applicants. Applicants own this one-level home that consists of 3 bedrooms, 2 bathrooms, back yard, and garage. Applicants are the only 2 adults residing in the home and have both received fingerprint clearance from the department. DAY CARE AREAS: infant play room, preschool playroom, Bedroom#1 (isolation room) Bedroom #2(Napping Room Only), Bathroom #1, and backyard. OFF LIMIT AREAS: Kitchen, Bedroom #3, bathroom inside bedroom #3, living room, dining room, Garage, gated off backyard area to right of children’s area. The Off-limits areas are made inaccessible with child safety door handle locks. The applicants were notified that any off-limits area are not to be used as a daycare areas without prior approval from the department. The hours of operation are Monday through Thursday 8:00am-5:30pm and Fridays 8:00 am – 5:00pm. Ages of children to planned to care are 4months up to 4years of age. cont pg 2 >>>>

NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Jaclyn Naves
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2025

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: SILVEIRA, JESSICA & SILVEIRA, PATRICIA	FACILITY NUMBER: 214002750
	VISIT DATE: 12/12/2025

NARRATIVE

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Entrance to the home for childcare will be to the left of the home through a side gate where all postings will be posted.

Applicants plan to provide children in care with a meal service that consists of Breakfast lunch and 2 snacks. Parents are asked to provide specific foods for their children if they have a specific dietary need. Food storage, preparation, and sanitization were discussed. Applicants stated that for infants in care, if still on formula or breast milk applicant will have families provided any additional milk to meet infant needs.

LPA observed that there were two Pack N Play Pens in the home, ready to be used additional sleeping equipment is still being used at currently licensed facility until relocation. Applicants will provide napping mats, and Pack N Plays for children to rest and nap on and additional sheets which will be washed 3 times a week. Parents will provide blankets and will be sent home at the end of the week to be washed. LPA informed applicants that cribs or play pens for napping infants must be free of loose articles, materials, and objects. LPA informed applicants that cribs for napping infants must have a mattress with a tight-fitting sheet only. Safe sleep was discussed with applicants.

LPA and applicants inspected the entire home both indoor and outdoor areas for health and safety hazards.

LPA observed the day care areas to be clean and safe. LPA observed day care areas to be equipped with a variety of age-appropriate toys, materials, and furniture that are in good working condition. Flooring in home includes wood floors that were observed to be clean and free of stains. LPA observed foam mats in both infant and preschool playrooms to be clean and free of any stains and in good condition. LPA observed electrical outlets to be made inaccessible with child safety covers. LPA observed off limit areas to be properly barricaded.

LPA observed three smoke and carbon monoxide detectors present in the home and all 3 were tested and found to be operating correctly. Home includes a fully charged 2-A:10-B:C fire extinguisher. Applicants have a fully equipped First Aid Kit. Per applicant, there are no weapons or firearms in the home, and no one smokes in the home. The home has a fireplace that will be barricaded with a cover that applicant’s plant to install.
cont pg 3 >>>>

NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Jaclyn Naves
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2025

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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SILVEIRA, JESSICA & SILVEIRA, PATRICIA	FACILITY NUMBER: 214002750
	VISIT DATE: 12/12/2025

NARRATIVE

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Home also has vents throughout the home that have been properly covered by furniture pieces and made inaccessible to children. Bathroom sink and toilet were observed to be in proper working condition. LPA did not observe any accessible poisons, chemicals or other hazardous materials in bathroom cabinets. All poison, chemicals or other hazardous materials have been made inaccessible.

LPA did not observe pools, wading pools, hot tubs, spas, fishponds or similar bodies of water on the property. Applicant also confirmed that there were no similar bodies of water on the facility property.

Applicants were reminded baby walkers, bouncers, jumpers, and any other similar items are not to be used for children in care. LPA reminded applicant emergency disaster drills are to be conducted and documented at least once every six months.

Applicants’ CPR/First Aid certifications are current and will expire 5/2027 and 3/2026 and Applicants Mandated Reporter Trainings Expire 9/2026 and 2/2026. LPA reminded applicants CPR/First Aid training and Mandated Reporter training must be renewed every two years to remain compliant. Additionally, applicants were also reminded Mandated Reporter training must be renewed every two years by all staff working with children to remain in compliance.

LPA observed the backyard to be clean and free of any hazards. The backyard is fenced and is at least 4 ft high. The play area was observed to be gated and has artificial turf to help absorb any falls. LPA observed several play structures for children to use. Additionally, the back yard has a large tarp that provides shade during warm weather.

The applicants plan to use a designated cell phone and are aware that it must remain within the home during daycare hours. The Applicants plan to isolate sick children in bedroom number #1. The applicants intend to purchase child care insurance, they currently have a valid policy for other facility and will transfer over once relocation is complete.

cont pg 4 >>>>

NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Jaclyn Naves
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2025

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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SILVEIRA, JESSICA & SILVEIRA, PATRICIA	FACILITY NUMBER: 214002750
	VISIT DATE: 12/12/2025

NARRATIVE

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The applicants provided proof of control of property.

If the applicants provide care for a 13th and 14th child of school age, the applicant must use form LIC 9150 to notify the parents or guardians of all enrolled children. The Emergency Disaster Plan (LIC 610), Parent Rights (LIC 995A), License (once received) and the (LIC 9148) Earthquake Preparedness check list, (which was provided to applicants) must be posted in an accessible location where parents can see them. LPA reminded the applicant that at least one child is enrolled in and attending kindergarten or elementary school or transitional kindergarten and a second child is at least six years of age.

LPA reminded the applicants that once they are licensed, they both must be present at home and ensure that the children in her care are consistently supervised. Additionally, temporary absences should not exceed 20 percent of the daily care hours provided by the facility.

LPA reminded the applicants that once they are licensed, any duly authorized officer, employee, or agent of the Department shall, upon presentation of proper identification, enter and inspect any place providing personal care, supervision, and services at any time, with or without advance notice, to secure compliance with, or to prevent a violation of, the regulations adopted by the Department governing family child care homes
LPA informed the applicants that starting September 1, 2016, no one may be employed or volunteer at a family day care home without having been vaccinated against influenza, pertussis, and measles. LPA reminded the applicant that an individual who works in a family daycare home may submit a written declaration stating that they have declined the influenza vaccination. This exemption applies only to the influenza vaccine.

Applicants were reminded that all adults 18 and over living or working in the home, 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 licensed Family Child Care Home. 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.

cont pg 5 >>>>

NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Jaclyn Naves
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2025

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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SILVEIRA, JESSICA & SILVEIRA, PATRICIA	FACILITY NUMBER: 214002750
	VISIT DATE: 12/12/2025

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information, see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

LPA reviewed with applicants the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance checklist was provided to the applicants.

LPA discussed the safe sleep regulations with applicants and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep, as an additional resource. LPA also informed applicants 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.

On this date, 11/18/2025, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility address. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Applicants were 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.

LPA discussed with the applicant that the capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time.

cont pg 6 >>>>

NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Jaclyn Naves
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2025

LIC809 (FAS) - (06/04)

Page: 6 of 7

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: SILVEIRA, JESSICA & SILVEIRA, PATRICIA	FACILITY NUMBER: 214002750
	VISIT DATE: 12/12/2025

NARRATIVE

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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 athttps://www.cdss.ca.gov/inforesources/community-carelicensing/ subscribe and select the Child Care option to receive email communication.
The applicants will provide a list of individuals from the Guardian’s Background Check System and informed the LPA that she wished to update her facility roster.

Applicants emailed updated facility sketch to LPA

Prior to licensure, following is to be completed:

-barricade fireplace
-start date

During visit applicants explained to LPA that the heating system in the new home was not functioning, but they have reached out to a repair person. The applicants were quoted 8-10 days for it to be repaired. Due to this delay the applicants will relocate completely once it is up and running again. Applicants will communicate with LPA actual date to begin for children in new home and cease operation at currently licensed facility. LPA reminded Applicants home is still unlicensed and must not be used to care for children until LPA receives effective date to begin care.

Exit interview conducted and report was reviewed with the applicants, Jessica and Patricia Silveira.

NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Jaclyn Naves
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2025

LIC809 (FAS) - (06/04)

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