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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005623
Report Date: 04/05/2024
Date Signed: 04/05/2024 02:27:45 PM

Document Has Been Signed on 04/05/2024 02:27 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:ACQUA TODDLER HOUSEFACILITY NUMBER:
214005623
ADMINISTRATOR/
DIRECTOR:		MENDOZA, NICOLASFACILITY TYPE:
830
ADDRESS:96 PILGRIM WAYTELEPHONE:
(415) 755-7075
CITY:SAN RAFAELSTATE: CAZIP CODE:
94903
CAPACITY: 16TOTAL ENROLLED CHILDREN: 16CENSUS: 7DATE:
04/05/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:05 PM
MET WITH:Nico MendozaTIME VISIT/
INSPECTION COMPLETED:
02:27 PM
NARRATIVE
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On 4/5/2024, Licensing Program Analyst (LPA) Hanson Leong conducted an unannounced Plan of Correction (POC) visit to the Child Care Center (CCC) listed above. The purpose of this visit was to follow up with four deficiencies that were cited on 3/21/2024. LPA met with the Director, Nico Mendoza, and explained the purpose of the visit. Three toddlers, four infants, and four staff members were present during the visit. The four staff members present at the CCC have all received criminal record clearance from the department. The CCC operates within its capacity and in accordance with the required ratio of staff to children.

LPA reviewed the emergency disaster drill log and found the last emergency disaster drill was completed on 3/26/2024 and was properly recorded.

LPA reviewed the director’s Pediatric First Aid/CPR certification and found that it was completed on 3/29/2024 and will expire on 3/29/2026.

LPA reviewed the sleep logs of children under two years old and found them properly recorded.

The four deficiencies, CCR 101216(f), CCR 101429(a)(2)(C)(3), CCR 101174(d), and CCR 101174(d)(2) that were cited on 3/21/2024 will be cleared during the visit.

Cleared POC letters were given to the Director, Nico Mendoza.

No deficiencies were issued today during LPA's visit.

A Notice of Site Visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Director, Nico Mendoza.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE: DATE: 04/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/05/2024
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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