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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004738
Report Date: 12/10/2025
Date Signed: 12/10/2025 01:21:01 PM

Document Has Been Signed on 12/10/2025 01:21 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:MENDONCA, MAYRAFACILITY NUMBER:
384004738
ADMINISTRATOR/
DIRECTOR:		MENDONCA, MAYRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 716-1751
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94131
CAPACITY: 12TOTAL ENROLLED CHILDREN: 11CENSUS: 11DATE:
12/10/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:35 AM
MET WITH:S1 and Mayra Mendonca TIME VISIT/
INSPECTION COMPLETED:
01:30 PM
NARRATIVE
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On December 10, 2025 at approximately 8:35am, Licensing Program Analyst (LPA) Quimbo conducted an unannounced, annual inspection. LPA met with licensee's spouse, S1, and explained the purpose of the visit. Upon LPA's arrival, licensee was not present. Per S1, licensee was bringing their minor child to school. LPA was granted entry into the home.

Present during LPA's visit included 10 children (4 infants and 6 preschool age), licensee's spouse (S1) and two assistants (A1 and A2). Hours of operation are Monday through Friday 8:00am to 5:00pm. Overnight care is occasionally provided. Licensee operates home as a Portuguese immersion program.

The DAY CARE AREAS located on the ground level of the home is the lobby area and backyard. Located on the second level of the home (main day care area) are the living room, dining area (napping space), kitchen, and bathroom #1. The OFF LIMIT AREAS located on the ground level is the garage (pass by only to backyard). Located on the second level of the home is the balcony (pass by only to backyard) and entire third level of the home. There are stairs in the home that are made inaccessible with a child safety gate.

At approximately 9:00am, LPA observed an additional preschool age child arrive to the home and was carried in by A2. Present during LPA's visit included 11 children (4 infants and 7 preschool age). Home is operating within capacity limits during LPA's visit.

At approximately 9:10am, licensee arrived to home. LPA continued visit with licensee. Licensee lives in the home with S1 and their minor child. Adults living in the home have fingerprint clearance on file.

LPA observed day care areas to be clean and organized. Flooring in main day care area includes rugs that are clean, free of stains. Per licensee, rugs are vacuumed daily. Furniture and equipment for children were observed to be in good condition. Toys and materials were observed to be clean and age appropriate. Per licensee, toys and materials are sanitized weekly. LPA observed electrical outlets in day care areas to be made inaccessible with child safety covers. There are windows in the main day care area that were observed to have a child safety lock installed. There is also a fireplace in the main day care area that was made inaccessible to children by a child safety gate and/or furniture.
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NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/10/2025
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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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: MENDONCA, MAYRA
FACILITY NUMBER: 384004738
VISIT DATE: 12/10/2025
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Children eat in the kitchen. There is age appropriate tables and chairs for children. LPA observed cabinets and drawers in kitchen to have child safety locks. LPA also observed knives to be stored in a high shelf, inaccessible to children. Licensee provides a food service that includes breakfast, lunch and snacks. Reusable utensils and plates are utilized and are sanitized daily in home's dishwasher. Per licensee, no children currently enrolled have allergies.

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/

Bathroom for children's use is located next to the living room. Bathroom was observed to be equipped with age appropriate toileting equipment. LPA observed bathroom to be in working condition. There is a diaper changing table in the living room for diapering children. Licensee provides diapers and wipes to diapering children. LPA observed diapers and wipes to be appropriately stored. LPA also observed a garbage bin with a tight fitting lid next to the diaper changing table.

Children sleep in the dining area. Licensee utilizes pack and play cribs for infants and floor mats for preschool children. Sheets and blankets are provided by licensee and are laundered weekly. LPA observed pack and play cribs and mats to be stored away in a closet, when not in use. Per licensee, infants who sleep in cribs, sleep in a crib that are free of loose articles and materials. Licensee maintains sleeping logs for infants. LPA observed sleeping logs include the 15 minute time stamp of when the napping infant is checked on and licensee's signature.

LPA discussed the safe sleep regulations with licensee 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 licensee of the importance of checking for and removing any 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.
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NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2025
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: MENDONCA, MAYRA
FACILITY NUMBER: 384004738
VISIT DATE: 12/10/2025
NARRATIVE
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Backyard is fully enclosed and fenced. Per licensee, backyard is not currently in use. There are stairs in the backyard that lead to the second level balcony that are made inaccessible to children at the bottom of the stairs and the top of the stairs. There are a variety of outdoor toys and materials in the backyard. LPA did not observe any pools, spas or bodies of water on site.

Home is equipped with a fully charged fire extinguisher, dual smoke and carbon monoxide detector and first aid kits. Carbon monoxide detector was tested during today's visit and was observed to be working. Licensing documentation is posted in main entrance of home, available for review. Emergency disaster drills are conducted and documented. Last disaster drill was conducted 7/25/2025. A childcare roster was maintained and made available for LPA's review.

LPA reviewed facility's records that included children's records and staffs' records. Children's records are complete with emergency contact information and immunization records. Licensee's CPR and First Aid certification is current and will expire 10/2027. Licensee's Mandated Reporter certification on record expired as of 1/2025. Licensee stated they renewed their certificate, however, were unable to log into web page to provide certificate to LPA. Type B citation was issued. Licensee stated they will work on obtaining proof of completed certificate and submit to LPA.

LPA observed A2 to be working with children during today's visit. LPA did not observe A2 to have fingerprint clearance on file. Type A citation was issued and civil penalty was assessed. Licensee stated A2 previously worked at another childcare facility.

Licensee 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 also observed S1 and A2 to be working with children, however, do not have proof of immunizations available for review. LPA reminded licensee all staff working with children must be immunized and have proof of immunizations against Pertussis, Measles and Influenza (or declination of Influenza). LPA also reminded licensee TB clearance must be maintained for all staff working with children. Type B citation was issued. Licensee stated staff completed vaccines in Brazil. LPA observed A1 to have fingerprint clearance, a current Mandated Reporter certificate and proof of immunizations during today's visit.
(Continue Report on Page 4...)
NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2025
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: MENDONCA, MAYRA
FACILITY NUMBER: 384004738
VISIT DATE: 12/10/2025
NARRATIVE
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LPA Quimbo informed licensee Mayra Mendonca that this report dated December 10, 2025 documents one Type A citation which shall be posted for 30 consecutive days as there is/are immediate risks to the health, safety or personal rights of children in care.

Also, LPA Quimbo informed the licensee to provide a copy of this licensing report dated December 10, 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.

Licensee 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, the Licensee Mayra Mendonca, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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

During today's visit, licensee was issued a Type A citation for an un-fingerprinted adult working with children. Civil penalty was assessed. Licensee was issued a Type B citation for licensee's expired Mandated Reporter certification and a Type B citation for not maintaining immunization records for staff working with children. A plan of correction was discussed. Appeal rights were provided to licensee.

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

Exit interview conducted and report was reviewed with the licensee, Mayra "May" Mendonca.
NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/10/2025 01:21 PM - It Cannot Be Edited


Created By: Catrina Quimbo On 12/10/2025 at 12:32 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: MENDONCA, MAYRA
FACILITY NUMBER: 384004738

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/10/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1596.871(c)(1)(A)
Administration of Child Day Care Licensing
Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision(f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above. LPA observed A2, an un-fingerprinted adult, working with children which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 12/11/2025
Plan of Correction
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Licensee stated A2 worked at another childcare center prior to A2 working in licensee's home. LPA and licensee discussed fingerprint requirement for all adults working in a licensed family child care home. Licensee stated A2 will go through the livescan process by the POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Marie Rodriguez
NAME OF LICENSING PROGRAM MANAGER:
Catrina Quimbo
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 12/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/10/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/10/2025 01:21 PM - It Cannot Be Edited


Created By: Catrina Quimbo On 12/10/2025 at 12:32 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: MENDONCA, MAYRA
FACILITY NUMBER: 384004738

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/10/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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 observation, interview and record review, the licensee did not comply with the section cited above. Licensee's Mandated Reporter certificate has expired as of 1/2025, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/17/2025
Plan of Correction
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Licensee stated they renewed their Mandated Reporter certificate, however, certificate was not available for LPA's review. Licensee stated they will provide proof of completed certificate or renew their certificate by POC due date. LPA reminded licensee Mandated Reporter certification must be AB1207.
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above. LPA observed S1 and A2 working with children, however, did not observe immunization records for S1 nor A2, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/09/2026
Plan of Correction
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Licensee stated S1 and A2 have immunization records that were completed in Brazil. Licensee stated they will have S1 and A2 work with their physicians to obtain proof of immunizations above. Proof of immunizations for S1 and A2 will be submitted to LPA by POC due 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.
Marie Rodriguez
NAME OF LICENSING PROGRAM MANAGER:
Catrina Quimbo
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 12/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/10/2025


LIC809 (FAS) - (06/04)
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