410503400-9-17-2025-05-CC-LGOZ-DLLRY3-20250917132540

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 410503400
Report Date: 09/17/2025
Date Signed: 09/17/2025 01:25:58 PM

Document Has Been Signed on 09/17/2025 01:25 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:	SEA BREEZE SCHOOL		FACILITY NUMBER:	410503400
ADMINISTRATOR/ DIRECTOR:	WEBER, JERELYN		FACILITY TYPE:	850
ADDRESS:	900 EDGEWATER BLVD		TELEPHONE:	(650) 574-5437
CITY:	FOSTER CITY	STATE: CA	ZIP CODE:	94404
CAPACITY: 126	TOTAL ENROLLED CHILDREN: 126	CENSUS:	DATE:	09/17/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:45 AM
MET WITH:	Jerelyn Weber		TIME VISIT/ INSPECTION COMPLETED:	01:40 PM

NARRATIVE

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On 9/17/2025 at 8:50AM., Licensing Program Analyst (LPA), Luis Gomez met with Director, Jerelyn Weber. The purpose of today's visit was explained and was for an unannounced- annual random inspection. Present was the Director, 15 staff supervising 73 children. Facility is a combination center with a school-age program onsite. Facility days and hours of operation are Monday- Friday, 7:30AM- 6:00PM.

The preschool program utilizes five classrooms: Room #1, 2- 3 years old; Room #2, 3 year-old; Room #3, 3 year-old; Room #4, 4-5 year-old; Room #5, 3 year old; and two outdoor play areas (Courtyard and Preschool Yard). LPA inspected facility, indoors and outdoors, for health and safety hazards.

At 9:05AM., LPA observed the following: classrooms were neat and orderly, with age-appropriate playthings and materials available for the children. Facility doorways, floors, and ground surfaces were clean and clear of obstructions. Classrooms were equipped with activity areas available for the children. LPA observed several tables/ chairs; scaled to the appropriate size.

The books, supplies, and puzzles inspected were in good repair. Labeled cubbies are available for storage of belongings. The off-limit areas had been made inaccessible lockable doors. Children’s bathrooms were observed safe and sanitary. The toilets and faucets inspected are in operating condition. LPA observed diaper changing tables available for the staff. Trash bins used for solid waste had been covered.

For nap/ scheduled rest, classrooms have foldable mats, made from a cleanable plastic material. Per director, the napping supplies are washed weekly by the families. The facility has adequate ventilation, lighting, and comfortable temperature. The facility had a functioning telephone service; carbon monoxide detector; and fire extinguisher (2A10BC). (REFER TO 809C, FOR CONT.)

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Luis Gomez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2025

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: SEA BREEZE SCHOOL	FACILITY NUMBER: 410503400
	VISIT DATE: 09/17/2025

NARRATIVE

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At 10:05AM, LPA reviewed the outdoor play areas (Courtyard and Preschool Yard). LPA observed both areas have absorbent turf material installed on ground surfaces. The areas are completely enclosed with tall fencing, and was free of hazardous plants or objects. Areas for shaded rest were available for the children, and the climbing structure had been anchored. The sandbox inspected was free of hazardous items.
Per director, drinking water readily available (inside and outside) for children to drink as they wish.

At 10:35AM., LPA reviewed the facility records including a sampling of 5 children and 8 personnel files.

LPA reminded director, staff background transfer / association must be processed prior to staff's presence in a license childcare facility.

The personnel files reviewed contained: Notice of Employee Rights (LIC9052); Proof of Teacher Qualification; and Acknowledgement to Report Suspected Child Abuse (LIC9108).

LPA reminded the director to ensure staff’s proof of immunization are stored in facility records. Advisory Note: Technical Violation (LIC9102TV) was issued.

LPA advised the director to ensure staff’s proof of completed mandated reporter training certification (AB1207) are stored in facility records. Advisory Note: Technical Violation (LIC9102TV) was issued.

The children’s files were reviewed and contained the: Notification of Parent’s Rights (LIC995); Immunization Record; and Personal Rights (LIC613A); Consent form for Medical Treatment (LIC627), and Identification and Emergency Information (LIC700).

The director’s cardiopulmonary resuscitation (CPR) / pediatric first aid certification was current, expiring on: 2/2/2024.

Facility emergency disaster drill (Fire and Earthquake) was completed on: 9/8/2025.

Required postings in facility and included the: Facility License; Notification of Parent’s Rights (PUB394); Personal Rights (LIC613A); The Passenger Safety Laws (PUB269); Lead Testing Results; and Emergency Disaster Plan (LIC610).

The children’s medication and pertaining documents were reviewed during inspection.

At 12:00PM., Based on record review, interview, and observation, LPA confirmed, lead exceedance reported higher than the allowable level (5.5ppb) on water fixture, C. (REFER TO 809C, FOR CONT.)

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Luis Gomez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2025

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: SEA BREEZE SCHOOL	FACILITY NUMBER: 410503400
	VISIT DATE: 09/17/2025

NARRATIVE

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This facility provides Incidental Medical Services- IMS. LPA reviewed storage of medication and equipment / supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02CCP. When any IMS is provided, an updated Plan of Operation that includes 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 are available at: https://www.ada.gov/resources/child-care-centers/.

Director, Jerelyn Weber was reminded that all adults 18 and over, 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 Child Care Center. A civil penalty of $100.00 minimum/ day for maximum of 5 days or, if the penalty is repeat violation, for a maximum of 30 days per person will be assessment if this regulation is violated.

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 athttps://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

Based on today's inspection, deficiencies were observed in the areas evaluated according to Title 22 Division 12 Chap. 1 Ca. Code of Regulations and cited on LIC809D. An exit interview discussing the facility evaluation report was conducted with Director, Jerelyn Weber, and signature on this form acknowledges the receipt of these documents.

This report must be made available in the facility for public review. Notice of site visit was provided and must remain posted for 30 days. Director was advised, any additional questions/ concerns to contact the San Bruno Regional Office, Mon-Fri, 8:00am-5:00pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov'

Director refused to sign report, LIC809D, LIC809

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Luis Gomez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/17/2025 01:25 PM - It Cannot Be Edited

Created By: Luis Gomez On 09/17/2025 at 12:42 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: SEA BREEZE SCHOOL	FACILITY NUMBER: 410503400
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/17/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Request Denied

Type B

Section Cited

1217003.1(b)(1)

101700.3 California Lead Action Level at Child Care Centers (b)(1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	At 12:00PM., Based on record review, interview, and observation, LPA confirmed, action level exceedance reported to the Department higher than the allowable level (5.5ppb) on water fixture, C. This poses a health and safety risk to children in care.
	POC Due Date: 09/18/2025
	Plan of Correction
1 2 3 4	During inspection, LPA confirmed fixture C, located in perish hall has been removed and is no loner in service. (Photo taken) Per director, facility has no plan at this time to replace fixture C at this time. For water services in the Perish Hall, refillable water bottle will be brought to the area by the staff. Deficiency issued was cleared during inspection.

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.

	Marie Rodriguez
NAME OF LICENSING PROGRAM MANAGER:

	Luis Gomez
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2025

LIC809 (FAS) - (06/04)

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