214005224-8-7-2025-05-CC-JNAS-DKBVCK-20250807161916

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 214005224
Report Date: 08/07/2025
Date Signed: 08/07/2025 04:19:37 PM

Document Has Been Signed on 08/07/2025 04:19 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:	SANTIZO, RINA & ALVAREZ, JUAN		FACILITY NUMBER:	214005224
ADMINISTRATOR/ DIRECTOR:	SANTIZO,RINA&ALVAREZ,JUAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 456-0623
CITY:	SAN RAFAEL	STATE: CA	ZIP CODE:	94901
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 12	DATE:	08/07/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:27 PM
MET WITH:	Rina Santizo & Juan Alvarez		TIME VISIT/ INSPECTION COMPLETED:	04:35 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 8/7/2025, Licensing Program Analysts (LPAs) Naves and Van, made an unannounced annual visit to the Family Child Care Home listed above. The LPAs were granted entry by the Licensees, Rina Santizo and Juan Alvarez. The LPAs explained the purpose of the visit to the Licensees. All the individuals listed on the facility’s roster have been granted permission to work or be present in a childcare facility. The LPAs observed the Licensee and her assistant supervising 4 infants, and 8 pre-school aged children. Children's capacity and ratio requirements were observed to be in compliance. During the visit, there were 2 dogs present in the home. Licensees hours of operation are Monday-Saturday 6:00am-9:00pm weekdays and 8:00am-6:00pm on Saturday. Day-care Areas: Living Room, Family Room, Dining Room, Half Bathroom and Yard Area. Off Limit Areas: Laundry Room (Pass through only), Kitchen (Pass through only) and Entire Upstairs Area (Bedroom #2, Bedroom #3, Bedroom #4, Bathroom #1, Bathroom #2, Bathroom #3, and staircase. The LPAs and the Licensees both performed careful inspections of the day-care facility to look for any potential health and safety hazards. Toys and equipment that are suitable for children of the proper age range are provided at the day-care. The building has sufficient lighting and ventilation. LPAs observed child proof straps to prevent access to off limit areas were broken and not in working order. cont pg 2 >>>>

NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Jaclyn Naves
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2025

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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Document Has Been Signed on 08/07/2025 04:19 PM - It Cannot Be Edited

Created By: Jaclyn Naves On 08/07/2025 at 03:11 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: SANTIZO, RINA & ALVAREZ, JUAN	FACILITY NUMBER: 214005224
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/07/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

102425(b)

Infant Safe Sleep

(b) Cribs or play yards shall be free from all loose articles and objects. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above an infant was observed sleeping with a full bottle in their mouth while sleeping on their tummy, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 08/08/2025
	Plan of Correction
1 2 3 4	Licensees must provide LPA with a written plan of correction for how infants under the age of 24 months will not have any loose articles in their sleeping areas.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Ali Zebila
NAME OF LICENSING PROGRAM MANAGER:

	Jaclyn Naves
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 08/07/2025 04:19 PM - It Cannot Be Edited

Created By: Jaclyn Naves On 08/07/2025 at 03:11 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: SANTIZO, RINA & ALVAREZ, JUAN	FACILITY NUMBER: 214005224
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/07/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.622(c)

Administration of Child Day Care Licensing

(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview and record review, the licensee did not comply with the section cited above in which poses/posed a potential health, safety or personal rights risk to persons in care. Licensee and co-licensee did not have proof of TB test results avaiable for review.Licensees have previously been cited for this in the past.
	POC Due Date: 08/14/2025
	Plan of Correction
1 2 3 4	Licensees must provide proof of TB test results to LPA by due date of 8/14/25 and must maintain a copy in their files for review upon request to prevent reocurring deficiency from happening again.

Type B

Section Cited

CCR

102418(g)

Immunizations

(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation interview and record review, the licensee did not comply with the section cited above in which, 3 out of 12 children files were missing immunization records which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/14/2025
	Plan of Correction
1 2 3 4	Licensees must provide proof of childrens immunnizations to LPA by due date of 8/14/25 and will be requesting and adding to childrens files upon enrollment to facillity to prevent recurring deficiency.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Ali Zebila
NAME OF LICENSING PROGRAM MANAGER:

	Jaclyn Naves
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2025

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: SANTIZO, RINA & ALVAREZ, JUAN	FACILITY NUMBER: 214005224
	VISIT DATE: 08/07/2025

NARRATIVE

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The day-care facility is equipped with a smoke detector, a carbon monoxide detector, and a fire extinguisher that is ready for use. Every garbage can that was observed to have been covered and LPAs reminded Licensees all electrical outlets need to be covered. LPAs reminded licensees that all products for cleaning and washing, detergents, and any other materials that could put children in danger are stored out of their reach. The LPAs did not find any walkers, bouncers, or other comparable objects during its inspection.

According to licensees there is a weapon/firearm in the home that belongs to their adult son and is located in an off-limit area. LPAs reminded licensees of proper storage, in a locked safe or a trigger lock be in place, additionally ammunition must be stored and locked away separately. A technical violation was issued today.

The LPAs observed that the facility did not have any pools, spas, or other types of bodies of water of any kind.
The outdoor area was enclosed by a fence and equipped with play equipment for the children to use.
According to the licensee, she provides food and snacks for the children. LPAs reminded the licensee about the importance of sanitation and proper food preparation.

The LPAs observed that the facility had most of the posted required forms, including the facility license, Notification of Parental Rights, and Notification of Personal Rights LPAs reminded the Earthquake Preparedness Checklist was missing.
The licensee is aware that smoking is not permitted in a family childcare facility.

The sleeping/resting area was clean and sanitary. LPAs observed playpens, sleeping mats, sheets, and blankets in the sleeping/resting area.
LPAs observed a sleeping infant with a full bottle in their mouth as they slept on their tummy. Co-Licensee immediately removed the bottle from infant’s mouth.
cont pg 3 >>>>

NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Jaclyn Naves
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2025

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: SANTIZO, RINA & ALVAREZ, JUAN	FACILITY NUMBER: 214005224
	VISIT DATE: 08/07/2025

NARRATIVE

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LPAs reminded all infants under the age of 24 months are to be free of any loose articles in their sleeping area while sleeping.

LPAs reviewed infant sleep logs and found them to be improperly logged. LPAs reviewed and explained to the licensees the importance of infant safe sleep and reviewed the proper documentation of sleep logs which are to be conducted once every 15 minutes of infant falling asleep. Licensee was only documenting the time child was sleeping.

LPAs reviewed 12 children’s files and confirmed that all twelve children did not have complete files that include their emergency contact and medical information. LPAs found that not all children's files contained their immunization records.

LPAs reviewed the two licensees' files and found them to be incomplete. LPAs also found that the two licensees possess a current Pediatric First Aid/CPR certification, which expires on 11/2025. LPAs found that the two licensees did complete their Mandated Reporter Training and expires on 8/2026. LPAs reminded both licensees that Mandated Reporter Training must be taken every two years. Mandated Reporter Training may be taken at www.mandatedreporterca.com.

The LPA reviewed the facility's emergency drill log. According to the facility’s emergency drill log, the facility's emergency drills are carried out twice a year with last one being conducted 6/12/2025.

Licensees were reminded of past due licensing fees being over due and was provided with Pin number to make payment. LPAs reminded licensees annual fees are due yearly on or before their anniversary date.

cont pg 4 >>>>

NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Jaclyn Naves
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2025

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: SANTIZO, RINA & ALVAREZ, JUAN	FACILITY NUMBER: 214005224
	VISIT DATE: 08/07/2025

NARRATIVE

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Licensees 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.

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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.
LPAs discussed the safe sleep regulations with licensee 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. LPAs also informed licensee 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.

Licensees were informed of the MyChildCarePlan.org website; 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.

During the exit interview, the licensees Rina Santizo and Jose Alvarez confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.
cont pg 5 >>>>

NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Jaclyn Naves
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2025

LIC809 (FAS) - (06/04)

Page: 7 of 8

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: SANTIZO, RINA & ALVAREZ, JUAN	FACILITY NUMBER: 214005224
	VISIT DATE: 08/07/2025

NARRATIVE

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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.

LPAs informed the licensees to provide a copy of this licensing report dated 8/7/2025 that documents any Type A citations to the parents or guardians of all children currently enrolled by the next business day or the next day the children are in care and to the parents or guardians of any newly enrolled children for a period of 12 months from the date of this report. The deadline for providing this information is the next day, 8/8/2025.

For the purposes of verification, the child's file needs to have either a signed Acknowledgement of Receipt of Licensing Report (LIC 9224) or another type of written statement.

The licensees were given the following forms : LIC 9108, LIC 9148, LIC 610, LIC 9227, LIC 9224. and LIC 999.

Please refer to LIC 809D for today’s citations.

A copy of today's report and the facility’s appeal rights were given to the Licensees, Rina Santizo and Jose Alvarez.

A Notice of Site Visit was given, and LIC 809D (documenting Type A deficiencies) must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Licensees, Rina Santizo and Jose Alvarez.

NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Jaclyn Naves
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2025

LIC809 (FAS) - (06/04)

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