214002757-1-15-2026-05-CC-JNAS-DQCTE6-20260115133924

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 214002757
Report Date: 01/15/2026
Date Signed: 01/15/2026 01:39:42 PM

Document Has Been Signed on 01/15/2026 01:39 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:	VALDIVIA, ELIZABETH		FACILITY NUMBER:	214002757
ADMINISTRATOR/ DIRECTOR:	VALDIVIA, ELIZABETH		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 755-7392
CITY:	SAN RAFAEL	STATE: CA	ZIP CODE:	94901
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	01/15/2026
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:15 AM
MET WITH:	Elizabeth Valdivia		TIME VISIT/ INSPECTION COMPLETED:	02:00 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 January 15, 2026, Licensing Program Analyst (LPA) Naves conducted a scheduled, pre-licensing visit. LPA met with the applicant, Elizabeth Valdivia, and explained the purpose of the visit and was granted entry. Applicant is currently licensed for facility 214005677 with a capacity of 14 children. Applicant submitted a relocation application to department January 8, 2026. Fire clearance has been obtained. Applicant lives in the home with her husband and 4 children (1adult and 3 minor children) and her dog who is vaccinated. Applicant and all adults residing in the home have fingerprint clearance on file. Applicant plans to operate 7 days a week from 4:00 am to 11:00pm. Applicant plans to care for children ages 2 months to 9 years old. The applicant rents the home which is a multi-level home with two levels. Home includes a living room, kitchen, dining room, 3 bedrooms, one bathroom, an in-law unit (ground floor) which has 2 bedrooms, a bathroom, kitchen and living room, an upper covered patio deck and a backyard that is divided by a gate, an enclosed indoor pool room and a garage. Applicant will provide a meal service for children in care which consists of breakfast, lunch and 2 snacks. Food preparation, sanitization and children's allergies were discussed. LPA reminded applicant children who bring their own food to facility must be labeled with the child's individual names. con pg 2 >>>>

NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Jaclyn Naves
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2026

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

FACILITY NAME: VALDIVIA, ELIZABETH	FACILITY NUMBER: 214002757
	VISIT DATE: 01/15/2026

NARRATIVE

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The DAY CARE AREAS are located on the second level of the home that includes the living room (play room), Bedroom #1 play room Bedroom #2 nap room bathroom, kitchen, dining room upper deck outdoor play area and lower backyard play area. The OFF LIMIT AREAS are bedroom #3 entire ground floor (in law unit) and indoor pool room and garage.

Access to the upper and lower level of the home includes stairs that are made inaccessible with a child safety gates. LPA informed co-applicants off limit areas are not to be used as a day care area without prior approval from the department.

LPA observed the day care areas to be clean and safe. There are a variety of toys, materials and furniture that are new and in good condition. Flooring in the home is hard wood all around. The play rooms and nap room have rugs that were observed to be free of stains. Cubbies were observed for children to use for their personal belongings.

There is a fireplace in the living room that is made inaccessible to children with furniture. LPA observed furniture to be secured. Cabinets in day care areas were observed to have child safety locks installed. The kitchen cabinets have child safety locks, and the stove has knob covers installed. In the kitchen a washer and dryer were observed to be stacked and have child locks and have also been barricaded by a gate as an extra security measure. Wall heaters in the home were found to have inner mesh covers.

LPA observed electrical outlets in day care areas to be made inaccessible with child safety covers. Home is equipped with several charged fire extinguishers, multiple first aid kits, and multiple smoke and carbon monoxide detectors. LPA tested all smoke/ carbon monoxide detectors in family room, which were observed to be in working condition.

There is a diaper changing table in the playroom. Bathroom for children's use was observed to be in working condition. LPA did not observe accessible poisons or cleaning solutions in bathroom.

cont pg 3 >>>>

NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Jaclyn Naves
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2026

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

FACILITY NAME: VALDIVIA, ELIZABETH	FACILITY NUMBER: 214002757
	VISIT DATE: 01/15/2026

NARRATIVE

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LPA observed poisons and cleaning solutions to be made inaccessible behind child safety locked cabinets and/or in home's high shelves, inaccessible to children. Knives in the kitchen are also made inaccessible. LPA did observe a pool on the premises that is enclosed and made inaccessible to applicant and children. Room is made inaccessible by a barrier on one side of sliding door. LPA observed only 1 entrance to pool room. Pool is not currently being used and is empty. LPA reviewed pool regulation with applicant and explained requirements for all pools starting January 2025. During the visit applicants husband purchased and brought home an alarm that is compliant with ASTM International Standard F2208 to install.

LPA and applicant toured the upper patio and found numerous age appropriate play toys. The flooring is wood and artificial turf and a carpet that was observed to be clean cover the floor. There is a door from the kitchen to the upper patio. LPA observed a gate to the stairs leading to the ground floor and a gate at the bottom as well. The lower living unit is made inaccessible to children by a locked door. Applicant and LPA toured the back yard and checked for any hazards. The back yard is enclosed by a fence and is equipped with outdoor play equipment that is in good condition. The areas around and under high climbing equipment, swings, slides, and similar equipment were observed to be cushioned with artificial grass that absorbs falls. There is another gate that is locked that prevents access to the second half of the backyard and to the indoor pool room.

Children will sleep in cribs and cots. LPA observed cribs to have mattresses with tight fitting sheets. LPA also observed cribs to be free of loose articles and materials. Applicant plans for children (who sleep on cots) to provide their own blankets that will be sent home weekly for laundering. Applicant provides infants sheets for cribs and washes them weekly or as needed.

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-andresources/
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.
cont pg 4 >>>>

NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Jaclyn Naves
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2026

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

FACILITY NAME: VALDIVIA, ELIZABETH	FACILITY NUMBER: 214002757
	VISIT DATE: 01/15/2026

NARRATIVE

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Applicant was reminded baby walkers, bouncers, jumpers and any other similar items are not to be used for children in care. Applicant stated they are aware emergency disaster drills are to be conducted and documented at least once every six months.

Applicant's discipline policy was discussed. Applicant uses separation and communication as a plan to communicate with children to calm them down and to intervene. Applicant maintains communication with families about children's daily habits. The designated isolation area for sick children will be in the kitchen, separate from other children in care.

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.

applicants CPR/First Aid training is current and will expire 08/2026. Applicants Mandated Reporter training certification is also current and will expire 12/26. LPA reminded applicants Mandated Reporter training must be renewed every two years. Updated Statement Acknowledgement Requirement to Report Suspected Child Abuse Applicant has all required immunizations on file. LPA observed licensing documents to be properly posted and available for review in the home. Per applicant, there are no weapons or firearms in the home or any smoking in the home.

applicant was reminded that all adults 18 and over living in the home, persons who provide 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 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: 01/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2026

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: VALDIVIA, ELIZABETH	FACILITY NUMBER: 214002757
	VISIT DATE: 01/15/2026

NARRATIVE

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The applicant provided proof of control of property. Because the applicant rents/leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).

LPA reminded applicant she must be present at facility for 80% of operating hours. Applicant states that they understand that they are the primary person responsible for operating and providing care and supervision to the children, regardless if the applicant hires helpers or assistants to work with them. Applicant understands that they may only be absent from the home no more than twenty percent of the operating hours. During the twenty percent absence applicant understands that they may designate another person to provide care and supervision to the children who is qualified with Mandated Reporter Training, Pediatric CPR and First Aid Training, has obtained criminal record clearances, child abuse index checks, a TB test with results, immunizations as required by law, and has a signed Criminal Record Statement and Acknowledgement to Report Suspected Child Abuse forms. Capacity limits and ratios for a large family child care were reviewed and discussed with the applicant on this date. LPA reminded applicant when operating with a large capacity an assistant must be present and must operate with a small capacity, if she is alone.

Entrance checklist was provided to the applicant for reference to future visit requirements.
On this date, 1/9/2026, 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 addresses. 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.

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 athttps://www.cdss.ca.gov/inforesources/community-carelicensing/ subscribe and select the Child Care option to receive email communication.

The Applicant's home meets the licensing requirements of a Family Child Care Home (FCCH) today, and licensure is recommended upon supervisor review.
Exit interview conducted and report was reviewed with the applicant, Elizabeth Valdivia.

NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Jaclyn Naves
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2026

LIC809 (FAS) - (06/04)

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