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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410505801
Report Date: 03/04/2025
Date Signed: 03/04/2025 04:22:02 PM

Document Has Been Signed on 03/04/2025 04:22 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:SAN MATEO PARENT'S NURSERY SCHOOLFACILITY NUMBER:
410505801
ADMINISTRATOR/
DIRECTOR:		MIE NAKAMURAFACILITY TYPE:
850
ADDRESS:1732 MONTE DIABLO AVETELEPHONE:
(650) 347-1955
CITY:SAN MATEOSTATE: CAZIP CODE:
94401
CAPACITY: 38TOTAL ENROLLED CHILDREN: 38CENSUS: 16DATE:
03/04/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:26 PM
MET WITH:Mie NakamuraTIME VISIT/
INSPECTION COMPLETED:
04:40 PM
NARRATIVE
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On March 4, 2025, at approximately 12:20 PM, Licensing Program Analyst (LPA) Zeynep Basak conducted an unannounced annual inspection, met with the Site Supervisor, Mie Nakamura, and explained the purpose of the visit. The facility operates Monday to Friday from 7:30 am to 6:00 pm.

Upon entry, LPA observed five staff members, including the supervisor. and 16 preschool children were present. The facility operates within its capacity and complies with the staff/child ratio on this day.
LPA checked the staff member's background clearance on the Guardian website and found one of the newly hired staff member does not have criminal record clearance. LPA discussed it with the director and Mie asked the S1 leave the facility and return after receives the clearance letter. A Type A violation will be cited and Civil Penalty will be assessed today.

LPA inspected 2 daycare rooms divided by a partition, two bathrooms, and the outdoor play area with the director. LPA observed that the facility has 2 combined smoke alarms and carbon monoxide detectors and a fully charged fire extinguisher model 2A:10BC located in the center. The director stated facility conducts a fire drill twice a month and the latest one was conducted on 2/12/2025.

LPA observed the facility has age-appropriate furniture, toys, and educational materials in each classroom. The facility floor and rugs are in good condition and free of any hazards.
Sleeping mats were observed in the napping area and per the director, blankets and sheets were provided by the facility.
LPA observed the children's bathroom- toilets and sinks were clean, sanitary, and in working condition and the water temperature was proper. LPA observed all cleaning solutions and other chemicals are properly stored and made inaccessible to the children.

See page 2.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Zeynep Basak
LICENSING EVALUATOR SIGNATURE: DATE: 03/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/04/2025
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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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: SAN MATEO PARENT'S NURSERY SCHOOL
FACILITY NUMBER: 410505801
VISIT DATE: 03/04/2025
NARRATIVE
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LPA observed the outdoor play area with the director and found there is a variety of play and sports equipment available for the children. All play structures are in good repair and the playground is free from health and safety hazards.
LPA observed the facility has a fully stocked first aid kit and a functioning telephone. Per the director, there are six children who have allergy and using medication. LPA observed three of the EpiPen expired in last year. The director has taken those to the office to return to parents and replace with updated ones. A Type B violation will be issued.
The director stated they use the office as an isolation area for ill children to wait for their guardians.
According to Mie, the facility provides three snacks in addition to drinking water, breakfast and lunches are brought from home.

Per the director, the facility is using an electronic sign-in/out app called Pro Care and LPA observed all authorized representatives have signed for today.

All posting requirements are met by the facility and the License, Parent's Rights, and California Child Passenger Safety Law observed by the LPA.

LPA reviewed the facility records, 6 children's files, and 4 staff files. LPA found all required documents in the children's file including immunization records, LIC 700, and Personal-Parents Rights. Mia stated her CPR has expired in January 2024 and have not been renewed. LPA also observed some staff's immunization records and Mandated Reporter training certificate not in the file and could not provide to the LPA to review during the inspection. LPA discussed these with the director and Type B violation will be issued on LIC 809D page today.

The director is aware that all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for


drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.

See page 3.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Zeynep Basak
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2025
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: SAN MATEO PARENT'S NURSERY SCHOOL
FACILITY NUMBER: 410505801
VISIT DATE: 03/04/2025
NARRATIVE
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The director was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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 Child Care Center. 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.
Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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/.

The director was advised that for any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.cdss.ca.gov

A Type A violation will be cited and the Civil Penalty will be assessed. Two Type B citations and two Technical Violation will be issued on LIC809D page.
LPA Zeynep Basak informed the director, Mie Nakamura that this report dated 3/4/2025 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, LPA Basak informed the director to provide a copy of this licensing report dated 3/4/2025 that documents any Type A citation(s) 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.
The facility's appeal rights were given to the director.
A notice of site visit was provided to the director and must remain posted for 30 days.
An exit interview was conducted, and the report was reviewed with the director, Mie Nakamura.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Zeynep Basak
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/04/2025 04:22 PM - It Cannot Be Edited


Created By: Zeynep Basak On 03/04/2025 at 03:49 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: SAN MATEO PARENT'S NURSERY SCHOOL
FACILITY NUMBER: 410505801

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/04/2025

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 in having a person without fingerprint clearance which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 03/05/2025
Plan of Correction
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The director will provide LIC 9163 for S1 in 24 hours and ensure the person receives a cleared letter before coming to the center.
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.
SUPERVISOR'S NAME:Daniel J Oquendo
LICENSING EVALUATOR NAME:Zeynep Basak
LICENSING EVALUATOR SIGNATURE:
DATE: 03/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/04/2025


LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 03/04/2025 04:22 PM - It Cannot Be Edited


Created By: Zeynep Basak On 03/04/2025 at 03:49 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: SAN MATEO PARENT'S NURSERY SCHOOL
FACILITY NUMBER: 410505801

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/04/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216(f)
Personnel Requirements
(f) At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities.

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 in not having a valid CPR training certificate which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/18/2025
Plan of Correction
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The director will provide an enrollment receipt in two weeks and a copy of the certificate in a month to the LPA via email.
Type B
Section Cited
CCR
101217(d)
Personnel Records
(d) All personnel records shall be maintained at the child care center and shall be available to the licensing agency for review.

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 in not providing the staff immunization record/documents to the licensing staff to review which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/07/2025
Plan of Correction
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The director will provide a copy of the immunization records of the staff to the LPA via email on the designated date above.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Daniel J Oquendo
LICENSING EVALUATOR NAME:Zeynep Basak
LICENSING EVALUATOR SIGNATURE:
DATE: 03/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/04/2025


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