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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410505801
Report Date: 03/11/2025
Date Signed: 03/11/2025 03:36:03 PM

Document Has Been Signed on 03/11/2025 03:36 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: 18DATE:
03/11/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:57 PM
MET WITH:Mie NakamuraTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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On March 11, 2025, at approximately 2:00 p.m., Licensing Program Analyst (LPA) Zeynep Basak conducted an unannounced Plan of Correction (POC) visit. LPA met with the director, Mie Nakamura, and explained the purpose of the visit.

Present during the visit were the director, a staff member (with 6 units), and 18 preschool children. The facility was operating within the required staff/children ratio.

On March 4, 2025, LPA Zeynep Basak conducted an annual inspection. During the visit, LPA cited a Type A violation for an adult (A1) working with children without a criminal background clearance, which resulted in a $100 civil penalty. LPA also issued two Type B citations for the director not having a valid CPR training certificate, which expired in January 2024, and for missing personnel records that were not available for LPA’s review during the inspection.

On March 11, 2025, LPA conducted a POC visit to address the Type A and part of the Type B deficiencies. During the POC visit, LPA observed a staff member without a criminal background clearance but confirmed that the A1 name appears on the Guardian website with eligible clearance and is associated with the facility. LPA also confirmed that the missing staff member records have been placed in the file for review.

As of today, LPA Basak confirmed that the Type A and part of the Type B deficiencies have been corrected by the facility representatives, and clearance letters have been generated and provided to the director.

During today’s visit, LPA observed a signed and completed Acknowledgment of Receipt of Licensing Reports (LIC9224) placed in the children’s file, and a Notice of Site Visit posted in the facility from the previous visit. No deficiencies were cited today under CCR, Title 22, Division 12, Chapter 3.

LPA provided a copy of the POC letters to the licensee. (See page 2.)
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Zeynep Basak
LICENSING EVALUATOR SIGNATURE: DATE: 03/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/11/2025
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: 03/11/2025
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A Notice of Site Visit was issued and must remain posted for 30 days. Failure to comply with posting requirements will result in an immediate civil penalty of $100.

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: 03/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025
LIC809 (FAS) - (06/04)
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