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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410517546
Report Date: 10/13/2026
Date Signed: 10/13/2026 11:43:33 AM

Document Has Been Signed on 10/13/2026 11:43 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:LA HONDA-PESCADERO U.S.D.FACILITY NUMBER:
410517546
ADMINISTRATOR/
DIRECTOR:		ERIKA HAYSFACILITY TYPE:
850
ADDRESS:620 NORTH STREETTELEPHONE:
(650) 879-0286
CITY:PESCADEROSTATE: CAZIP CODE:
94060
CAPACITY: 30TOTAL ENROLLED CHILDREN: 13CENSUS: 11DATE:
10/13/2026
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:50 AM
MET WITH:Preschool Director, Kristen LindstromTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
NARRATIVE
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On October 13th, 2026, at approximately 9:50AM, Licensing Program Analysts (LPAs) Alvarado and Tse conducted an unannounced plan of correction visit at the facility. LPAs met with Lead Teacher, Patricia Marin Saenz (S1), and then met with Preschool Director Kristen Lindstrom (D1). LPAs explained the purpose of the visit. Present during the visit was S1 and two teachers supervising 11 children. This facility is located on the premises of Pescadero Elementary School.

During an annual visit on August 26, 2026, the facility was cited three citations regarding lead testing, personnel records, and storage of medication. Lead testing was not completed by the required deadline of January 1, 2023. Personnel records were observed to be incomplete. Children’s medication was not observed to be stored with its original packaging.

LPAs reviewed storage of medication. LPAs confirmed that children’s medication was stored in its original packaging, along with parental consent and physician's instructions. Per D1, the lead testing appointment had to be re-scheduled. LPAs also reviewed three staff files and observed them to be incomplete.

The citation regarding storage of medication has been cleared as of today. The citations regarding lead testing and staff files have not been cleared. PIN 26-11-CCP was discussed and a copy was provided. An Entrance Checklist (LIC125) and a sample drill log were also provided. See LIC809D for deficiencies cited today October 13th, 2026, regarding lead testing and staff records.

Appeal rights were provided and explained. A notice of site visit was provided and must remain posted for 30 days. Exit interview was conducted and report was reviewed with facility representative, Kristen Lindstrom.
Ali Zebila
Diana Alvarado
DATE: 10/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/13/2026
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 10/13/2026 11:43 AM - It Cannot Be Edited


Created By: Diana Alvarado On 10/13/2026 at 10:44 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: LA HONDA-PESCADERO U.S.D.
FACILITY NUMBER: 410517546

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/13/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/13/2026
Section Cited
CCR
1597.16(a)(1)

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(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.

This requirement is not met as evidenced by:
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Licensee shall test all water fixtures used for food preparation and consumption for lead. Forms LIC999, LIC9275, and LIC9276 shall be submitted to LPA Alvarado via email once initial sampling is conducted.
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Based on record review, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
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Type B
11/13/2026
Section Cited
CCR101217(a)

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(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information:

This requirement is not met as evidenced by:
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Staff files shall be maintained current and complete. An Entrance Checklist (LIC125) was provided to S1 for reference. Completed staff files shall be sent to LPA Alvarado via email.
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Based on record review, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
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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.
Ali Zebila
NAME OF LICENSING PROGRAM MANAGER:
Diana Alvarado
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/13/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/13/2026


LIC809 (FAS) - (06/04)
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