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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005623
Report Date: 05/11/2026
Date Signed: 05/11/2026 03:34:33 PM

Document Has Been Signed on 05/11/2026 03:34 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: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: 8DATE:
05/11/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:51 PM
MET WITH:Julia MacarioTIME VISIT/
INSPECTION COMPLETED:
03:50 PM
NARRATIVE
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On 5/11/2026, Licensing Program Analyst (LPA) Naves conducted an unannounced annual visit to the Child Care Center (CCC) listed above. LPA met with teacher Julia Macario and explained the purpose of the visit. 8 children (2 infants 6 toddlers) and 4 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.

The centers hours of operation are Monday-Friday 7:00 am – 6:00pm. LPA provided staff member with LIC 125 Entrance checklist.

LPA observed that all required documents, such as the facility license, waivers, notification of parental rights, notification of personal rights, car seat law, emergency disaster plan, and daily activities, were displayed in the CCC.

LPA and the staff member conducted an inspection to identify potential health and safety hazards. LPA observed that the inside of the CCC was clean, safe, sanitary, and in good repair. The CCC is equipped with a fully stocked first aid kit, functioning smoke and carbon monoxide detectors, (detector was not tested as children were napping) and a fully charged fire extinguisher. LPA observed that the classrooms were equipped with age-appropriate toys, furniture, and educational materials. LPA observed that each child has an individual permanent or portable storage space for his/her clothing, personal belongings, and/or bedding at the CCC.

At short time later the Director Nico Mendoza arrived LPA provided LIC 125 Entrance checklist.

The Director mentioned disaster drills are conducted once every 6 months. LPA reminded the Director that a log must be kept when disaster drills are conducted. The Director understood, a technical violation was issued.

cont pg 2 >>>>

NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Jaclyn Naves
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/11/2026
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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Document Has Been Signed on 05/11/2026 03:34 PM - It Cannot Be Edited


Created By: Jaclyn Naves On 05/11/2026 at 02:59 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: ACQUA TODDLER HOUSE
FACILITY NUMBER: 214005623

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/11/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216(g)(2)
Personnel Requirements
(2) Each person specified in (g) above shall have a health-screening report signed by the person performing the screening. This report shall indicate the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in staff members did not have LIC 503 and immunization records which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/05/2026
Plan of Correction
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Director will ensure all staff has Lic 503 completed and have current immunizations records no later than end of business day 6/5/26. A follow up visit may be required.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review the licensee did not comply with the section cited above in 4 out of 5 staff members did not have a current Mandated Reporter Certification, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/05/2026
Plan of Correction
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Director will ensure all staff has a current mandated reporter certification completed by 6/5/2026 and provide proof to LPA no later than end of business day 6/5/26. A follow up visit may be required.
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: 05/11/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/11/2026


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: ACQUA TODDLER HOUSE
FACILITY NUMBER: 214005623
VISIT DATE: 05/11/2026
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LPA observed that the CCC maintains a paper record of the children’s attendance. A review of the sign in sheet which is kept in a binder and has a note on the front cover that parents must sign their full name when signing children in/out for the day, did not contain parent or authorized representative signatures with full names. LPA reminded director parents must sign in/out with their full names, a technical violation was issued.

LPA observed bathrooms to be clean and in working condition. Garbage bins in bathrooms were observed to have tight-fitting lids. The sink was observed to be in working condition and not providing water warmer than 120 degrees Fahrenheit. LPA observed all toilets, handwashing, and bathing facilities at the CCC appeared to be in safe and sanitary operating condition.

LPA observed that all accessible cabinets and drawers in classrooms did not contain hazardous materials or poisons. LPA observed that poisons, cleaning solutions, and chemicals were stored on high shelves or shelves with child safety locks to make them inaccessible to children in the classroom.

According to the director, the children are responsible for bringing their own food and snacks to the CCC.

LPA observed that a half door was present between the two different age groups.

LPA observed that a fence enclosed the outdoor playground and that the equipment and furniture appeared to be in good condition. The areas around and under high climbing equipment, swings, slides, and similar equipment were cushioned with material that absorbs falls. LPA observed that the CCC did have a fish tank in the toddler room, which was secured with a cover.

LPA observed that the CCC has a specific sleeping/resting area for children. The area was equipped with cribs, cots, mats, and blankets, which appeared to be comfortable and safe for the children to sleep in. LPA observed a clean diaper-changing station within arm’s reach of an adult sink, complete with wipes and diapers. Both the classroom and diaper disposal bins had tight-fitting lids. The mattresses appeared to be firm and covered with a fitted sheet appropriate to their size. The sheets appeared to fit tightly on the mattresses and overlapped the underside of the mattresses.

cont pg 3 >>>>

NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Jaclyn Naves
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2026
LIC809 (FAS) - (06/04)
Page: 6 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: ACQUA TODDLER HOUSE
FACILITY NUMBER: 214005623
VISIT DATE: 05/11/2026
NARRATIVE
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LPA reviewed the records of both the children and staff members. LPA reviewed the six children's records and found that all 6 files contained all necessary documents, including their Immunization Record, Admission Agreement, Personal Rights Identification and Emergency Information, Physician's Report, Notification of Parents' Rights, and Consent for Emergency Medical Treatment.

LPA reviewed the records of all the staff members and found that at least 1staff member had a current Pediatric First Aid/CPR certification and 1 staff member had a current Mandated Reporter Certification. LPA reminded director Mandated Reporter Certifications must be current and renewed every 2 years. LPA observed that the center maintains a sleep log for children under two years old and was properly logged. LPA reminded the director that each staff member must have their immunization records in their files.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.

For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP).

LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

Director was reminded that all adults 18 and over, 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 Child Care Center. 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 4 >>>>

NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Jaclyn Naves
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2026
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: ACQUA TODDLER HOUSE
FACILITY NUMBER: 214005623
VISIT DATE: 05/11/2026
NARRATIVE
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LPA discussed the safe sleep regulations with director 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 director 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. When any IMS is provided, an updated 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers

Director was 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.

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

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

Appeal Rights were given to the Director, Nico Mendoza.

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.

NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Jaclyn Naves
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2026
LIC809 (FAS) - (06/04)
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