384004865-2-6-2026-05-CC-CQUO-DR2UGY-20260206143506

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384004865
Report Date: 02/06/2026
Date Signed: 02/06/2026 02:35:14 PM

Document Has Been Signed on 02/06/2026 02:35 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:	RODRIGUEZ, ANA SARA		FACILITY NUMBER:	384004865
ADMINISTRATOR/ DIRECTOR:	ANA SARA RODRIGUEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 516-7818
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94132
CAPACITY: 12	TOTAL ENROLLED CHILDREN: 9	CENSUS: 5	DATE:	02/06/2026
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:50 PM
MET WITH:	Ana Sara Rodriguez		TIME VISIT/ INSPECTION COMPLETED:	03:45 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 February 6, 2026 at approximately 12:50pm, Licensing Program Analyst (LPA) Quimbo conducted an unannounced, annual inspection. LPA met with licensee, Ana Sara Rodriguez, and explained the purpose of the visit. Present during LPA's visit included licensee, 3 enrolled children, licensee's 2 minor children and 3 staff. Per licensee, remainder of enrolled children are sick and/or are not attending today's date. Licensee is operating within capacity limits during LPA's visit. Licensee lives in the home with their spouse and 2 minor children. Adults living in the home and adults present have fingerprint clearance on file. Hours of operation are Monday through Friday 7:30am to 4:30pm. The DAY CARE AREAS are the living room (main classroom), kitchen, dining area, hallway bathroom, and bedroom #2. The OFF LIMIT AREAS are licensee's bedroom and all closets. LPA observed off limit closets to be made inaccessible with child safety door handles. There are stairs in the home that are made inaccessible with a child safety gate at both the bottom of the stairs and the top of the stairs. With licensee, LPA inspected home for health and safety hazards. LPA observed the living room to include a variety of toys and materials. Tables and chairs for children were observed to be age appropriate and in good condition. LPA observed electrical outlets are made inaccessible to children with child safety covers. Toys and materials were observed to be in good condition. LPA observed a bin in the living room that is labeled for toys and materials to be sanitized. Per licensee, materials are sanitized daily. LPA observed poisons and cleaning solutions to be inaccessible to children, stored in home's high shelves and/or behind child safety locked cabinets. There are storage closets in the home that have child safety door handles. Home is equipped with a fully charged fire extinguisher, fully stocked first aid kit, emergency backpack and a combination of a smoke and carbon monoxide detector. (Continue report on page 2...)

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2026

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: RODRIGUEZ, ANA SARA	FACILITY NUMBER: 384004865
	VISIT DATE: 02/06/2026

NARRATIVE

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Bathroom for children's use is located on the second level of the home. LPA observed bathroom to be in working condition and equipped with age appropriate toileting materials. There is a potty chair on the lower level of the home. Per licensee, potty chair is sanitized after each use. There are children currently enrolled that are still in diapers. Per licensee, diapers and wipes are provided by children's families. LPA observed diapers and wipes to be appropriately stored and labeled with children's individual photos. Home is equipped with a garbage bin with a tight fitting lid.

Children sleep in the living room and dining area on floor mats. There is a pack and play crib for infants, if needed. Per licensee, infants under 12 months sleep in the pack and play crib. LPA observed crib to be folded and stored appropriately when not in use. Licensee stated they are aware cribs are to be free of all loose articles and objects.

Licensee maintains sleeping logs for infants. LPA reviewed sleeping logs for random months of October 2024, May 2025, July 2025, November 2025, and February 2026. LPA observed sleeping logs document the napping infant's sleeping position and the 15 minute time stamp of when the napping infant is checked on by staff.

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.

The outdoor area/backyard is an open communal area that is not in use. Per licensee, children utilize the local park and are always supervised by licensee and licensee's staff. LPA did not observe any bodies of water on site.

Licensee provides a food service for children over 12 months that includes breakfast, lunch and afternoon snack. Per licensee, no enrolled children currently have any allergies or modified diets. Reusable utensils and plates are utilized and are washed daily in the home. Children under 12 months bring their own food to the home. LPA observed children's containers and lunch bag to be labeled with the child's individual name.
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NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2026

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: RODRIGUEZ, ANA SARA	FACILITY NUMBER: 384004865
	VISIT DATE: 02/06/2026

NARRATIVE

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LPA observed kitchen's cabinets to have child safety locks installed. Knives were observed to be in a high shelf, inaccessible to children. LPA also observed stove, refrigerator and oven to have child safety locks installed.

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/.

LPA reviewed facility records that included children's records, staffs' records and licensee's record. Children's records are complete with emergency information and immunization records. LPA also observed Individual Infant Sleeping Plan forms (LIC9227) for infants. Staffs' records are also complete with required immunizations, current Mandated Reporter certifications and signed Employee Rights (LIC9052). Licensee's record is also complete with required immunizations, a current Mandated Reporter certification that will expire 10/2027, and a current Pediatric CPR and First Aid certification that will expire 3/2027.

Licensing documents are posted and made available for review in the main entrance of the home. Emergency disaster drills are conducted and documented twice a month. Last documented disaster drill was conducted 1/22/2026. Licensee maintains a childcare roster that was made available for LPA's review. Licensee also maintains liability insurance that was also made available for LPA's review. Per licensee, there are no weapons or firearms in the home.

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 Ana Sara Rodriguez 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.

No deficiencies were issued during today's visit. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Ana Sara Rodriguez.

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2026

LIC809 (FAS) - (06/04)

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