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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410500083
Report Date: 10/15/2026
Date Signed: 10/15/2026 11:42:00 AM

Document Has Been Signed on 10/15/2026 11:42 AM - 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:BUNKER HILL PARENTS PARTICIPATION NURSERY SCHOOLFACILITY NUMBER:
410500083
ADMINISTRATOR/
DIRECTOR:		TEELE, TIFFANY M.FACILITY TYPE:
850
ADDRESS:2145 BUNKER HILL DR, RM. 3-6TELEPHONE:
(650) 349-1581
CITY:SAN MATEOSTATE: CAZIP CODE:
94402
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 10DATE:
10/15/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:25 AM
MET WITH:Katie Pieruccini TIME VISIT/
INSPECTION COMPLETED:
12:00 PM
NARRATIVE
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On 10/15/2026 at 8:25AM., Licensing Program Analyst (LPA) Luis Gomez met with Director, Katie Pieruccini. The purpose of the visit was explained and was for an unannounced- case management inspection for an unusual incident, submitted to the Department on 9/15/2026. Present was director, and 3 staff, 7 guardians, supervising 10 children. LPA inspected facility for health and safety hazards.

During today’s inspection, LPA conducted interviews with director and staff.

Per incident report, on 9/14/2026, at 1:50PM., child in care (C1) was inside the art room when parent/volunteer left the child alone, entering outside hallway space. The child (C1) then left the art room through the bathroom/ off-limit area (kitchen) door, and past the entry gate. Per director, child was stopped by their parent/ volunteer shortly after. Per director, child (C1) was unsupervised for approximately 1-2 minutes.

The director stated since this incident, she has discussed with staff the importance of constant supervision of children in care. Per director, the facility has installed an additional safety lock on bathroom/ off-limit area door.

As a result of the occurrence of this incident, a violation of Title 22 Division 12 of Ca. Code of Regulations was observed, and deficiency was cited on the attached 809D. An exit interview was discussed with Director. A copy of this report with the appeal rights was provided, and signature of this form acknowledges receipt of these documents.

This report must be made available in facility for public review. The notice of site visit were given and must remain posted for 30 days. The director was advised to contact the Community Care Licensing Office, M-F, 8:00am-5:00pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov

Marie Rodriguez
Luis Gomez
DATE: 10/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/15/2026
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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Document Has Been Signed on 10/15/2026 11:42 AM - It Cannot Be Edited


Created By: Luis Gomez On 10/15/2026 at 11:03 AM
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: BUNKER HILL PARENTS PARTICIPATION NURSERY SCHOOL
FACILITY NUMBER: 410500083

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/15/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/26/2026
Section Cited
CCR
101229(a)(1)

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(a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.

This requirement was not met as evidenced by:
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The director will conducted a training with parent/volunteers and staff to discuss classroom expectation including: the requirement for constant visual supervision of children in care at all times.
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Based on evidenced collected, LPA confirmed child in care (C1) was left alone for 1-2 minutes, and had accessed the off-limit area of the building (kitchen).This poses an potential risk to the health and safety of children in care.
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Due 10/26/2026, director will submit proof of correction (meeting agenda, material discussed, and sign -in of participants) to the Department via email.

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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:
Luis Gomez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/15/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/15/2026


LIC809 (FAS) - (06/04)
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