214200188-5-6-2025-05-CC-JTSE-DGERR2-20250506131424

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 214200188
Report Date: 05/06/2025
Date Signed: 05/06/2025 01:15:31 PM

Document Has Been Signed on 05/06/2025 01:15 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:	TEIXEIRA, VERA & SOARES, LUIZ GUILHERME		FACILITY NUMBER:	214200188
ADMINISTRATOR/ DIRECTOR:	TEIXEIRA, V. & SOARES, L.		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 924-6194
CITY:	CORTE MADERA	STATE: CA	ZIP CODE:	94925
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 8	DATE:	05/06/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:45 AM
MET WITH:	Helper, Floriceli Ramirez		TIME VISIT/ INSPECTION COMPLETED:	01:30 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 5/6/2025, at approximately 9:45AM, Licensing Program Analysts (LPAs) Jonathan Tse and Nicole Tran conducted an unannounced annual visit at the facility. LPAs met with Helper, Floriceli Ramirez (H1), and explained the purpose of the visit. Present during the visit was H1, one helper, six preschool age children, and two infants. The hours of operation are 8:00AM to 5:30PM, Monday to Friday. Licensee was not present during today’s visit. Daycare Areas: Bedroom #2, Bedroom #3, Bathroom #2, Sunroom (Deck), Infant Napping Room (accessible through Sunroom), and Backyard. Off-limits Areas: Bedroom #1, Bedroom #4 (Sewing Room), Living Room, Kitchen, Bathroom #1, Laundry Room, Shed (located in Backyard), and Side Yard (separated from Backyard by Shed). LPAs and H1 inspected the home for any health or safety hazards. LPAs observed there to be a fully charged fire extinguisher that is at least size 2A10BC. There is a carbon monoxide detector present that was observed to be operational during the visit. Poisons, cleaning detergents, and other chemicals are stored inaccessible to children in care. There are no fireplaces or open-face heaters present in daycare areas. There are no stairs in the home. There are two pet dogs present in the home that are kept in off-limits areas. LPAs observed there to be age-appropriate toys and learning materials present. Furniture was observed to be age-appropriate and free of rough or sharp edges. The facility provides all meals for children in care. There are no children with food allergies present. Parents provide milk and bottles from home. Bottles are cleaned at the facility. Continued on Page Two

NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Jonathan Tse
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2025

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 11

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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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: TEIXEIRA, VERA & SOARES, LUIZ GUILHERME	FACILITY NUMBER: 214200188
	VISIT DATE: 05/06/2025

NARRATIVE

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The Infant Napping Room is accessed through the Sunroom. LPAs observed an infant sleeping alone with the door closed. The infant was observed to be napping with a bib. LPAs advised that all loose articles or objects must be removed from a crib while an infant is napping. LPAs additionally advised that the door to a room with a napping infant present must remain open at all times unless a provider is present with the infant. Per H1, sleep checks of 15-minute intervals during naps were not being conducted. Based on review of available sleep logs, nap times are documented only when children go to sleep and wake up.

In the outdoor play area, LPAs observed multiple play structures and shaded areas. There are swings, tricycles, and age-appropriate toys. LPAs noticed three tricycles were missing rubber handles, therefore exposing children to metal, rough edges and posing a potential health and safety risk for children in care.

Upon entry to the visit, H1 stated that they were supervising seven children, and that a second helper would be arriving shortly. Licensee was not present during the visit. LPAs observed that there was an infant napping in the Infant Napping Room, bringing the total number of children present to eight. Prior to the second helper’s arrival, H1 was supervising eight children by themselves. LPAs informed H1 that per regulation, if there is no additional helper present, the facility must operate within the limitations of a Small Family Child Care Home. LPAs informed H1 that a Type A deficiency shall be cited today for staffing ratio and capacity.

LPAs were unable to review staff, children, or facility records during the visit. LPAs confirmed that both helpers present had fingerprint clearance and were associated to the facility. Records were not made accessible for review. LPAs were unable to verify that an emergency drill was conducted within the last six months. A drill log was not made accessible to review during the visit. LPAs advised that records must be accessible for review.

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.
Continued on Page Three

NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Jonathan Tse
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2025

LIC809 (FAS) - (06/04)

Page: 3 of 11

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: TEIXEIRA, VERA & SOARES, LUIZ GUILHERME	FACILITY NUMBER: 214200188
	VISIT DATE: 05/06/2025

NARRATIVE

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Facility representative was reminded that all adults 18 and over living or working in the home, 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.

LPA discussed the safe sleep regulations with facility representative 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 facility representative 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, 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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the
ADA, available at: https://www.ada.gov/resources/child-care-centers/.

Facility representative 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.

During the exit interview, facility representative confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Continued on Page Four

NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Jonathan Tse
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2025

LIC809 (FAS) - (06/04)

Page: 4 of 11

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: TEIXEIRA, VERA & SOARES, LUIZ GUILHERME	FACILITY NUMBER: 214200188
	VISIT DATE: 05/06/2025

NARRATIVE

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See LIC809-D for deficiencies cited today regarding maintaining equipment in good repair, emergency drills, safe sleep, maintaining records accessible for review, ratio, and requirement of the Licensee to be present in the home. Appeal rights were provided and explained to H1.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Floricela Ramirez.

LPAs Tse and Tran informed facility representative Floricela Ramirez that this report dated 5/6/2025 documents one Type A citation which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPAs Tse and Tran informed the facility representative to provide a copy of this licensing report dated 5/6/2025 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Jonathan Tse
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2025

LIC809 (FAS) - (06/04)

Page: 5 of 11

Document Has Been Signed on 05/06/2025 01:15 PM - It Cannot Be Edited

Created By: Jonathan Tse On 05/06/2025 at 12:19 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: TEIXEIRA, VERA & SOARES, LUIZ GUILHERME	FACILITY NUMBER: 214200188
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/06/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

102416.5(e)

Staffing Ratio and Capacity

(e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above by not maintaining capacity requirements with only one provider present in the home which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 05/07/2025
	Plan of Correction
1 2 3 4	Licensee shall submit a plan of correction that shows a staff schedule that will ensure that there will be at least two providers present providing care for children when operating under the capacity requirements of a Large Familty Child Care Home. This shall be submitted to the Regional Office via email or mail. An office meeting may be scheduled at a future date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

	Jonathan Tse
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2025

LIC809 (FAS) - (06/04)

Page: 6 of 11

Document Has Been Signed on 05/06/2025 01:15 PM - It Cannot Be Edited

Created By: Jonathan Tse On 05/06/2025 at 12:19 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: TEIXEIRA, VERA & SOARES, LUIZ GUILHERME	FACILITY NUMBER: 214200188
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/06/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(d)

Operation of A Family Child Care Home

(d) The home shall provide safe toys, play equipment and materials. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above by not having handlebar covers on three out of three tricycles present which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/20/2025
	Plan of Correction
1 2 3 4	Tricycles shall be equipped with handlebar covers. Licensee shall ensure that all play equipment is maintained in good repair and replacements made as necessary. Proof of correction shall be submitted to the Regional Office via mail or email.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

	Jonathan Tse
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2025

LIC809 (FAS) - (06/04)

Page: 7 of 11

Document Has Been Signed on 05/06/2025 01:15 PM - It Cannot Be Edited

Created By: Jonathan Tse On 05/06/2025 at 12:19 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: TEIXEIRA, VERA & SOARES, LUIZ GUILHERME	FACILITY NUMBER: 214200188
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/06/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(9)(A)1

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. 1. The licensee shall document the drills, including the date and time of each drill. This documentation shall kept at the family child care home. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview, the licensee did not comply with the section cited above by not maintaining documentation of an emergency drill accessible for review which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/20/2025
	Plan of Correction
1 2 3 4	Licensee shall conduct an emergency drill and submit documentation of the drill to the Regional Office via mail or email.

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:

	Jonathan Tse
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2025

LIC809 (FAS) - (06/04)

Page: 8 of 11

Document Has Been Signed on 05/06/2025 01:15 PM - It Cannot Be Edited

Created By: Jonathan Tse On 05/06/2025 at 12:19 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: TEIXEIRA, VERA & SOARES, LUIZ GUILHERME	FACILITY NUMBER: 214200188
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/06/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(b)

Infant Safe Sleep

(b) Cribs or play yards shall be free from all loose articles and objects. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above by having a bib present in a crib with a napping infant, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/20/2025
	Plan of Correction
1 2 3 4	Licensee shall ensure that all loose articles or objects are removed when an infant is napping in a crib. A training shall be conducted, and a memo submitted, with all staff present during normal operating hours signing a meeting memo. This meeting memo shall be submitted to the Regional office by mail or email.

Type B

Section Cited

CCR

102417(a)

Operation of A Family Child Care Home

(a) The licensee shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise the children during his/her absence. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above by not being present in the home for 80 percent of operating hours during today's visit which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/20/2025
	Plan of Correction
1 2 3 4	Licensee shall notify the Regional Office when they will be away from the facility. An office meeting may be scheduled at a future date.

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:

	Jonathan Tse
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2025

LIC809 (FAS) - (06/04)

Page: 9 of 11

Document Has Been Signed on 05/06/2025 01:15 PM - It Cannot Be Edited

Created By: Jonathan Tse On 05/06/2025 at 12:19 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: TEIXEIRA, VERA & SOARES, LUIZ GUILHERME	FACILITY NUMBER: 214200188
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/06/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(j)(5)

Infant Safe Sleep

The provider shall supervise infants while they are sleeping and adhere to the following requirements: If the infant is sleeping in a separate room from where the provider is stationed, the door to the room the infant is sleeping in shall remain open at all times. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above by having one infant napping in the Infant Napping Room with the door closed and no provider present with them, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/20/2025
	Plan of Correction
1 2 3 4	The door to a room with napping infants shall be kept open or a provider shall be present in the same room. A training shall be conducted, and a memo submitted, with all staff present during normal operating hours signing a meeting memo. This meeting memo shall be submitted to the Regional office by mail or email.

Type B

Section Cited

CCR

102391(d)

Inspection Authority of the Department

(d) The licensee shall permit the Department to inspect, audit, and copy children's records or other family child care home records upon demand during normal business hours. Records may be removed if necessary for copying. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview, the licensee did not comply with the section cited above by not having children's records accessible and available for review by LPAS during the visit, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/20/2025
	Plan of Correction
1 2 3 4	Licensee shall ensure that all staff are aware of and know of the location of children's records. These records shall be made available to the Department upon request. A training shall be conducted, and a memo submitted, with all staff present during normal operating hours signing a meeting memo. This meeting memo shall be submitted to the Regional office by mail or email.

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:

	Jonathan Tse
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2025

LIC809 (FAS) - (06/04)

Page: 10 of 11

Document Has Been Signed on 05/06/2025 01:15 PM - It Cannot Be Edited

Created By: Jonathan Tse On 05/06/2025 at 12:19 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: TEIXEIRA, VERA & SOARES, LUIZ GUILHERME	FACILITY NUMBER: 214200188
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/06/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102416.1(d)

Personnel Records

(d) All personnel records shall be maintained at the child care home and shall be available to the licensing agency for review. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview, the licensee did not comply with the section cited above by not having personnel records available for review by LPAs during the visit, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/20/2025
	Plan of Correction
1 2 3 4	Licensee shall ensure that staff are aware of and know of the location of personnel records in the facility. A training shall be conducted, and a memo submitted, with all staff present during normal operating hours signing a meeting memo. This meeting memo shall be submitted to the Regional office by mail or email.

Type B

Section Cited

CCR

102425(j)(2)(D)

Infant Safe Sleep

Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above by not maintaining 15-minute sleep checks for sleeping infants, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/20/2025
	Plan of Correction
1 2 3 4	Infant sleep checks are to be conducted every 15 minutes. Licensee shall complete infant sleep logs and submit three days worth of infant sleep checks to the Regional Office by mail or email.

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:

	Jonathan Tse
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2025

LIC809 (FAS) - (06/04)

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