214005736-6-19-2026-05-CC-NTRN-DV7RYP-20260619132639

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 214005736
Report Date: 06/19/2026
Date Signed: 06/19/2026 01:27:26 PM

Document Has Been Signed on 06/19/2026 01:27 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	FITZPATRICK, IANA		FACILITY NUMBER:	214005736
ADMINISTRATOR/ DIRECTOR:	FITZPATRICK, IANA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(305) 335-6864
CITY:	NOVATO	STATE: CA	ZIP CODE:	94949
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	06/19/2026
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:15 AM
MET WITH:	Applicant, Iana Fitzpatrick		TIME VISIT/ INSPECTION COMPLETED:	01:40 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 June 19, 2026, at approximately 10:15am, Licensing Program Analyst (LPA) Nicole Tran conducted a scheduled, pre-licensing visit. LPA met with Applicant, Iana Fitzpatrick. Present during the visit was only Applicant. Applicant submitted a family child care home application on May 19, 2026 and fire clearance has since been granted and received by the Department. Applicant lives in the home with two minor children. Applicant has obtained fingerprint clearance. Applicant plans to operate Monday through Friday from 8:00AM to 5:30PM. Applicant plans to care for children ages 0 months to 6 years old. With Applicant, LPA inspected the entire home for health and safety hazards. The home is a two-story home with 4 bedrooms and 3.5 bathrooms. Day care areas: Playroom 1, Playroom 2 (Exploratorium), Playroom 3, Half Bathroom, Garden, and Backyard. Off-limit areas: Kitchen, Office, Bathroom 2 (in Office), Laundry Room, Entire Second Floor, Garage, and Front Yard. Off-limit areas have been secured with child safety gates and doorknob levers. Continued on Page Two

NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Nicole Tran
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2026

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 6

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 6

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: FITZPATRICK, IANA	FACILITY NUMBER: 214005736
	VISIT DATE: 06/19/2026

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 in all Playrooms include either carpets or rubber padding to provide cushioning for falls. LPA observed home to include a variety of age-appropriate toys, books, and equipment to be in good condition. Children’s furniture was free of rough, loose, or sharp edges. LPA observed electrical outlets to have safety covers or be barricaded by furniture. A changing table is in Playroom 1 and families will provide diapers and wipes. LPA observed Half Bathroom to be in working condition with age-appropriate toileting equipment.

Home is equipped with three fully charged fire extinguishers, a complete first aid kit, and multiple carbon monoxide and smoke detectors. A manual pull fire alarm is near the front entrance. There is a fireplace in Playroom 3 that has been barricaded. Applicant has emergency supplies, lanterns, and food in the closet by the front door. Per Applicant, there are no weapons or firearms in the home.

Applicant plans to provide a full food service that includes breakfast, lunch, and snacks. Food will be prepared and cooked in the kitchen. Food preparation, sanitization, children’s allergies and dietary restrictions were discussed with Applicant. Facility is a nut and honey-free program. Families are also welcome to provide children’s food if desired.

Drinking water is available from a filtered water system. Families will provide cups/water bottles and Applicant states they will wash and sanitize them daily. Applicant has a separate dishwasher to sanitize bottles.

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.

Isolation area for sick children will be near the front entrance by Playroom 1, separate from other children in care.

Continued on Page Three

NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Nicole Tran
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2026

LIC809 (FAS) - (06/04)

Page: 3 of 6

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: FITZPATRICK, IANA	FACILITY NUMBER: 214005736
	VISIT DATE: 06/19/2026

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

Applicant has two cribs and two pack and plays for infants to nap in. LPA observed the mattresses in the cribs to be properly sized with tight fitting sheets. Applicant has cots for older children to rest on. Families will provide children’s bedding materials and bring them home to wash as needed.

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 discussed sleep logs with Applicant. 15-minute sleep checks must be documented for all children under 24 months of age. Applicant was reminded baby walkers, bouncers, jumpers and any other similar items are not to be used for children in care.

LPA observed the Garden and Backyard to be entirely enclosed and fenced. There are age-appropriate toys and equipment in good condition. There are activity tables, a basketball hoop for young children, and a play kitchen. Grass and woodchips provide cushioning for children to play on. Trees and an umbrella provide shade for children.

Applicant’s pediatric CPR/First Aid training is current and will expire 6/2028. Applicant’s Mandated Reporter certification is also current and will expire on 1/2027. 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 the Department. LPA reminded Applicant emergency disaster drills are to be conducted and documented at least once every six months.

The Applicant provided proof of control of property.

Continued on Page Four

NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Nicole Tran
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2026

LIC809 (FAS) - (06/04)

Page: 4 of 6

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: FITZPATRICK, IANA	FACILITY NUMBER: 214005736
	VISIT DATE: 06/19/2026

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

The Applicant has not obtained a signed Property Owner/Landlord Consent form (LIC9149). Without this consent, the Applicant understands that, once licensed, they can operate with a maximum capacity of 12 children. If property owner/landlord consent is obtained in the future, the applicant is advised that a new Application for a Family Child Care Home License (LIC 279) must be submitted with a change of capacity fee of $25, to increase the capacity and provide care to 14 children.

LPA reviewed with Applicant the LIC 311D, Forms/Records to Keep In Your Family Child Care Home, for child’s records, personnel records, administrative records, and documents to be posted. Entrance Checklist was provided to the Applicant.

Applicant states they plan to purchase liability insurance for childcare. LPA informed the Applicant that if childcare insurance is not purchased, each parent must be given the Affidavit Regarding Liability Insurance for Family Childcare Home (LIC 282).

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.

Continued on Page Five

NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Nicole Tran
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2026

LIC809 (FAS) - (06/04)

Page: 5 of 6

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: FITZPATRICK, IANA	FACILITY NUMBER: 214005736
	VISIT DATE: 06/19/2026

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

On this date, June 19, 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.

The Applicant's home meets the licensing requirements of a Large Family Child Care Home (FCCH) today, and licensure is recommended and approved today, June 19, 2026.

Exit interview conducted and report was reviewed with the applicant, Iana Fitzpatrick.

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: 06/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2026

LIC809 (FAS) - (06/04)

Page: 6 of 6