214005733-5-8-2026-05-CC-NTRN-DTVT9D-20260508143147

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 214005733
Report Date: 05/08/2026
Date Signed: 05/08/2026 02:32:23 PM

Document Has Been Signed on 05/08/2026 02:32 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:	CASTIBLANCO PENUELA, DEYSI		FACILITY NUMBER:	214005733
ADMINISTRATOR/ DIRECTOR:	CASTIBLANCO PENUELA, DEYSI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 493-8755
CITY:	NOVATO	STATE: CA	ZIP CODE:	94947
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	05/08/2026
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:52 AM
MET WITH:	Applicant, Deysi Castiblanco Penuela		TIME VISIT/ INSPECTION COMPLETED:	02:45 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 May 8, 2026, at approximately 9:52AM, Licensing Program Analyst (LPA) Nicole Tran conducted a scheduled, pre-licensing visit. LPA met with applicant, Deysi Castiblanco Penuela. Present during the visit was only applicant. Applicant submitted a family child care home application on April 17, 2026. Applicant has obtained fingerprint clearance. Applicant plans to operate Monday through Friday from 8:00AM to 6:00PM. Applicant plans to care for children ages 3 months to 6 year olds.. With applicant, LPA inspected the entire home for health and safety hazards. Applicant lives in a single-level home with 3 bedrooms and 1 bathroom. Day care areas: Living Room Montessori, Hallway/Circulation, Baby Room, Multipurpose Child Room, Dining Room, Play Yard (backyard), and Side Path (side yard adjacent to the Garage). Off-limit areas: Bedroom #3, Office, Kitchen, Garage, Garden, and Side Yard (side yard adjacent to Baby Room and Multipurpose Child Room). Off-limit areas have been made inaccessible through use of child safety gates and latches. Applicant was informed that the Department must be notified prior to the use of designated off-limits areas. Isolation area for sick children will be in the Baby Room and Multipurpose Child Room, depending on their ages. Children will rest there until their families pick them up. Continued on Page Two

NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Nicole Tran
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2026

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 7

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 7

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: CASTIBLANCO PENUELA, DEYSI	FACILITY NUMBER: 214005733
	VISIT DATE: 05/08/2026

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

Page Two

LPA observed the day care areas to be clean and free of debris. Flooring throughout the home included soft padding to provide cushioning for falls. LPA observed home to include a variety of age-appropriate toys and equipment to be in good condition. Children’s furniture was free of rough, loose, or sharp edges. There are separate areas for infants and older children to play in. Hooks are available near the front entrance for children’s personal storage. Facility postings are also by the front entrance. Applicant states families will be able to sign children in/out using an electronic app, Brightwheel.

LPA observed electrical outlets throughout the home to have safety covers installed. Home is equipped with two fully charged fire extinguishers (size 2A10BC), a new first aid kit, and smoke detectors. There is a fireplace in the Living Room Montessori that has been barricaded by furniture and covered. Per applicant, there are no weapons or firearms in the home. Applicant was reminded that baby walkers, bouncers, jumpers and any other similar items are not to be used for children in care.

Applicant plans to provide a food service that includes morning and afternoon snacks. Snacks will be prepared in the kitchen. Families will provide children’s lunches and applicant can heat up their lunches if needed. LPA advised applicant that children who bring their own food to the facility must be labeled with the child’s individual names. Children will bring their own water bottles. Drinking water is available from a filtered water system. The Dining Room has an infant feeding table.

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) 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.

There are cots available for older children to nap on in the Multipurpose Child Room. Families will provide bedsheets/blankets and bring them home weekly to wash. Applicant has individual bins for children’s bedding so that no child’s bedding comes into contact with another.

Continued on Page Three

NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Nicole Tran
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2026

LIC809 (FAS) - (06/04)

Page: 3 of 7

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: CASTIBLANCO PENUELA, DEYSI	FACILITY NUMBER: 214005733
	VISIT DATE: 05/08/2026

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

Page Three

LPA observed the Bathroom to be in working condition with age-appropriate toileting equipment. All cabinets and drawers have child safety locks on them. Applicant stated children using the bathroom will always be supervised.

Changing tables are available in the Hallway/Circulation and Baby Room. Per applicant, families will provide diapers and wipes. There are multiple trash cans with tight-fitting lids to dispose of solid waste. The Baby Room has portable wooden cribs and soft padding. LPA observed the portable cribs to be free of loose articles with tight-fitting sheets on the mattresses. LPA and applicant discussed infant safe sleep requirements. Applicant showed LPA their infant sleep log templates. 15-minute sleep checks must be documented for all children under 24 months of age.

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.

LPA observed the Play Yard to be fully enclosed and fenced. There is age-appropriate toys and equipment in good condition available. There are activity tables and a play structure with a slide for children. Artificial turf and grass provide cushioning for falls. There is a swing on a tree and applicant states children will always be supervised when using it. There is a play pen area with soft padding for infants to play in as well.

The Side Yard (adjacent to Baby Room and Multipurpose Child Room) and Garden (fenced off area in the back corner of Front Yard) are off-limits and have been made inaccessible. LPA advised applicant to install an additional barricade to close the gap from the Garden fence to the main fence.

Continued on Page Four

NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Nicole Tran
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2026

LIC809 (FAS) - (06/04)

Page: 4 of 7

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: CASTIBLANCO PENUELA, DEYSI	FACILITY NUMBER: 214005733
	VISIT DATE: 05/08/2026

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

Page Four

Applicant’s pediatric CPR/First Aid training is current and will expire in April 2028. Applicant’s Mandated Reporter certification is also current and will expire on February 2027. LPA reminded Applicant that pediatric CPR/First Aid training and Mandated Reporter training must be renewed every two years. Applicant submitted their proof of required immunizations to department. LPA reminded applicant emergency disaster drills are to be conducted and documented at least once every six months. LPA provided applicant with an emergency drill log template. Applicant has current liability insurance for childcare.

The applicant provided proof of control of property.

Because the applicant leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC 9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).

With LIC 9149, Applicant is allowed to care for up to 14 children. LIC 9150, Parent Notification Additional Children in Care must be given to and signed by all enrolled families. LPA discussed capacity and ratio requirements with Applicant. Any children under 10 years of age will be counted in the capacity. A Family Child Care Home Capacity Regulations chart was provided to the applicant.

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. Entrance Checklist was provided to the Applicant.

LPA discussed the California Code of Regulations section 102417(a) which states that licensees may only have temporary absences that shall not exceed 20% of the hours that the facility is providing care per day. A substitute adult will care for and supervise children in their absence. The substitute adult must have criminal record clearance, current pediatric CPR/First Aid training, current Mandated Reporter certification, all required immunizations and paperwork on file. Applicant stated they understood.

Continued on Page Five

NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Nicole Tran
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2026

LIC809 (FAS) - (06/04)

Page: 5 of 7

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: CASTIBLANCO PENUELA, DEYSI	FACILITY NUMBER: 214005733
	VISIT DATE: 05/08/2026

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

Page Five

Applicant was reminded that all adults 18 and over living in the home, persons who provide 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 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.

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-care-licensing/subscribe and select the Child Care option to receive email communication.

On this date, May 8, 2026, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Continued on Page Six

NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Nicole Tran
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2026

LIC809 (FAS) - (06/04)

Page: 6 of 7

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: CASTIBLANCO PENUELA, DEYSI	FACILITY NUMBER: 214005733
	VISIT DATE: 05/08/2026

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

Page Six

Prior to recommended licensure, the following is to be completed:

- Additional barrier to secure the off-limits Garden area
- Shade installed for the infant area in the Play Yard
- Child safety gate installed at Office entrance
- Fire clearance granted

Exit interview conducted and report was reviewed with the applicant, Deysi Castiblanco Penuela.

Desk Duty is available Monday to Friday between 8:00AM – 5:00PM at (650) 266 -8800.

NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Nicole Tran
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2026

LIC809 (FAS) - (06/04)

Page: 7 of 7