214005718-4-4-2025-05-CC-NGAA-DFER6K-20250404124451

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 214005718
Report Date: 04/04/2025
Date Signed: 04/04/2025 12:45:09 PM

Document Has Been Signed on 04/04/2025 12:45 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:	ROSS COTTAGE NURSERY SCHOOL		FACILITY NUMBER:	214005718
ADMINISTRATOR/ DIRECTOR:	MICHELLE ZOILA SHAFFER		FACILITY TYPE:	860
ADDRESS:	802 COLLEGE AVENUE		TELEPHONE:	(415) 517-7417
CITY:	KENTFIELD	STATE: CA	ZIP CODE:	94904
CAPACITY: 15	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	04/04/2025
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:30 AM
MET WITH:	Michelle Zolia Shaffer & June Friedman		TIME VISIT/ INSPECTION COMPLETED:	01:00 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 April 4, 2025 at approximately 9:30am, Licensing Program Analysts (LPAs) Catrina Quimbo, Nathan Garcia and Licensing Program Manager (LPM), Marie Rodriguez conducted a scheduled, pre-licensing inspection. LPAs and LPM met with applicant, Michelle Zoila-Shaffer, and director, June Friedman, and explained the purpose of the visit. Application was submitted to department January 21, 2025. Fire clearance was obtained February 4, 2025. Applicant is requesting 15 preschool children (ages 2 years to entry into first grade). The designated director of program will be June Friedman. The facility will operate Monday through Friday, 8:00am to 3:00pm. The facility will operate in a multi-level area with a ground floor and second floor. Preschool program will operate on the ground floor level only. Second floor is off limits to children and will not be used for child care services at this time. The program will operate in Main classroom, Art/Stem classroom, K-Prep classroom, front outdoor area and back outdoor area . On the ground floor, facility includes a lobby area that will be the isolation area. Second floor of facility includes a staff restroom that can be used for sick children, if needed. Applicant has a child safety gate for the bottom of the stairs when lobby is in use as an isolation area. The facility was inspected, indoors and outdoors, for health and safety hazards, and measured to calculate capacity. Indoors: There are 3 spaces that will be utilized for the preschool program: Main classroom, Art/Stem classroom, and K-Prep classroom. Total indoor square footage equals 658.45 sq. ft. allowing for a capacity of 18 preschool children. LPAs observed areas to be ventilated with appropriate temperature. Preschool areas are equipped with furniture, toys and materials that were observed to be age appropriate and in good condition. LPAs observed children's materials to be clean and organized. Flooring in classrooms include carpets that are free of stains and hardwood floors that were also in good condition. Applicant plans to have tight fitting lid garbage bins in classrooms. (Continue Report on Page 2...)

NAME OF LICENSING PROGRAM MANAGER: Daniel J Oquendo
NAME OF LICENSING PROGRAM ANALYST: Nathan Garcia
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 5

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)

Page: 2 of 5

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: ROSS COTTAGE NURSERY SCHOOL	FACILITY NUMBER: 214005718
	VISIT DATE: 04/04/2025

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
26
27
28
29
30
31
32

(Continued, Page 2...)
Storage for children's belongings will be kept in the main classroom, with children's cubbies. LPAs observed electrical outlets in classrooms to be made inaccessible, with child safety covers. Poisons, cleaning supplies, and hazardous materials were observed to be stored in classrooms' high and in storage closet. There are multiple carbon monoxide detectors in classrooms that were tested during today's visit, which were observed to be in working condition. Facility is also equipped with multiple fully charged fire extinguishers, and fire alarm system.

Per applicant, children's medication, will be stored near the bathroom locker, inaccessible to children, if needed. If medication requires refrigeration, applicant will install a wall refrigerator.

This facility does not plan to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. 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) 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.

Program plans to provide napping children with floor mats. LPAs observed floor mats to be color coded for one side of the mat to be on the floor. Children's families are to provide pillows and blankets that will be sent home weekly for laundering. Applicant plans to provide sheets that will be laundered daily. Sheets will be stored appropriately so that they are not touching each other. Per applicant, floor mats will be sanitized weekly or as needed.

Applicant plans for isolation area to be in lobby area, separate from other children. Applicant stated children will always be supervised when isolated from other children. Program's discipline policy was discussed. Applicant's discipline policy will be communicating with the child and modeling behavior.

Children's restroom is located in back of the classroom. There's 1 sink and 1 toilet for children's use. Total allowable capacity for toilets is 15 children. Total allowable capacity for sinks is 15 children. LPAs observed sink and toilet to be in proper working condition. Applicant stated they are aware children must be supervised going to and from bathroom. LPAs reminded applicant water accessible to children cannot be more than 120 degrees Fahrenheit.
(Continue Report on Page 3...)

NAME OF LICENSING PROGRAM MANAGER: Daniel J Oquendo
NAME OF LICENSING PROGRAM ANALYST: Nathan Garcia
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2025

LIC809 (FAS) - (06/04)

Page: 3 of 5

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: ROSS COTTAGE NURSERY SCHOOL	FACILITY NUMBER: 214005718
	VISIT DATE: 04/04/2025

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
26
27
28
29
30
31
32

(Continued, Page 3...)
Program does not plan to provide a food service at this time. Children's families are to provide lunch and snacks that will be stored in their individual cubbies. LPAs reminded applicant and director children's materials must be labeled with their individual names.

Children are required to provide their own individual water bottles that will be refilled at center through purchased water containers. Applicant will maintain water cups and dispenser, if needed, for children.

The requirement for Lead Water Testing was discussed (H&S Code 1597.16). Applicant was reminded a facility licensed after July 1, 2022, must have their water fixtures (used for drinking and food preparation) tested for lead 180 days after licensure and every 5 years thereafter. LPA advised applicant to review PIN 21-21-CCP. Applicant plans to submit an attestation to department that no fixture is used for drinking or food preparation.

Outdoor: Outdoor area includes two yards that are located at the front and rear of the facility. Total outdoor area measures for 1315.10 sq. ft. allowing for a capacity of 17 preschool children. Both outdoor areas are fully enclosed and fenced. There is a play structure that is secured to the ground. There is sufficient shade in outdoor area from umbrellas. Flooring in outdoor area includes soft, artificial turf and soft padding. LPAs did not observe any pools, spas or bodies of water on site.

LPA reviewed with applicant and director, the LIC 311A, Records to Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

Applicant plans to communicate with children's families through phone calls and in person meetings. Applicant plans to have paper sign in/out sheets that will be maintained at facility. LPAs reminded applicant to conduct and document emergency disaster drills.

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, 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.
(Continue Report on Page 4...)

NAME OF LICENSING PROGRAM MANAGER: Daniel J Oquendo
NAME OF LICENSING PROGRAM ANALYST: Nathan Garcia
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2025

LIC809 (FAS) - (06/04)

Page: 4 of 5

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: ROSS COTTAGE NURSERY SCHOOL	FACILITY NUMBER: 214005718
	VISIT DATE: 04/04/2025

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
26
27
28
29
30
31
32

(Continued, Page 4...)
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 at https://www.cdss.ca.gov/inforesources/community-carelicensing/ subscribe and select the Child Care option to receive email communication.

Based on toilet to sink ratio, maximum number program can be licensed for is 15 preschool children.

LPAs and LPM will recommend for licensure, effective this date.

Exit interview conducted and report was reviewed with the applicant, Michelle Zoila-Shaffer.

NAME OF LICENSING PROGRAM MANAGER: Daniel J Oquendo
NAME OF LICENSING PROGRAM ANALYST: Nathan Garcia
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2025

LIC809 (FAS) - (06/04)

Page: 5 of 5