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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005623
Report Date: 02/16/2023
Date Signed: 02/16/2023 11:39:04 AM

Document Has Been Signed on 02/16/2023 11:39 AM - 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:ACQUA TODDLER HOUSEFACILITY NUMBER:
214005623
ADMINISTRATOR:MENDOZA, NICOLASFACILITY TYPE:
830
ADDRESS:96 PILGRIM WAYTELEPHONE:
(415) 755-7075
CITY:SAN RAFAELSTATE: CAZIP CODE:
94903
CAPACITY: 16TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
02/16/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Nicolas MendozaTIME COMPLETED:
11:45 AM
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On February 16, 2023 at approximately 9:00am, Licensing Program Analyst (LPA) Catrina Quimbo conducted a follow up pre-licensing inspection. LPA met with applicant, Nicolas Mendoza, and explained the purpose of the inspection. No children were present during visit.

Initial pre-licensing visit with applicant was conducted by LPA on February 2, 2023. During LPA's initial pre-licensing visit, following had to be completed:
-Completion of construction/ classroom set up in facility.
-Posting of licensing documentation.

Facility also required furnishing and equipment in classrooms and shade in outdoor area.
LPA's visit today was to verify needed corrections. LPA inspected facility indoors and outdoors for health and safety hazards. LPA observed facility to have same initial set up as initial pre-licensing inspection. No measurements were taken today.

Entrance to facility is located on the infant classroom side with a lobby. Facility includes two classrooms: infant classroom and toddler classroom. LPA observed both classrooms to be furnished with age appropriate equipment. LPA observed classrooms to have age appropriate furniture that were new and in good working condition. Both classrooms are equipped with Montessori toys and materials. Infant classroom includes carpeting for crawling and walking infants. Infant classroom also includes a separate napping room that is equipped with sufficient cribs.

Toddler classroom was observed to have a variety of Montessori materials that were observed to be new. Toddler classroom also includes a gross motor movement activity area that includes age appropriate balancing structures. LPA observed resilient padding of carpeting underneath structures. Storage for children's belongings are located inside the classroom with cubbies.

Children's bathrooms were observed to be equipped with a changing table that is within arm's reach to an adult sink. Garbage cans were observed to have tight fitting lids.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE: DATE: 02/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/16/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: ACQUA TODDLER HOUSE
FACILITY NUMBER: 214005623
VISIT DATE: 02/16/2023
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Both infant and toddler classroom include two accessible sinks that do not provide water that is warmer than 120 degrees Farenheit. Classrooms are equipped with working carbon monoxide detectors, fully charged fire extinguishers and fire alarm system.

Applicant was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

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.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. A Plan of Operation that includes 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: http://www.ada.gov/childqanda.htm

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.

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 platform.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:

DATE: 02/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: ACQUA TODDLER HOUSE
FACILITY NUMBER: 214005623
VISIT DATE: 02/16/2023
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To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website athttps://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

During inspection, LPA was provided copy of applicant's certification in 8 hours of preventative health and safety course.

LPA will approve for a provisional license of capacity of 16 (8 infants and 8 toddler option) children for facility on this date.

Prior to regular licensure, following must be completed:
-Submission of signed lease agreement.
-Installation of shade in outdoor area.
-Posting of licensing documentation.
-Separation of infant classroom to facility lobby (installation of gate).

Exit interview conducted and report was reviewed with the applicant, Nicolas Mendoza.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:

DATE: 02/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023
LIC809 (FAS) - (06/04)
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