<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002425
Report Date: 02/04/2025
Date Signed: 02/04/2025 02:14:05 PM

Document Has Been Signed on 02/04/2025 02:14 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:JACOBO, MARISELA A.FACILITY NUMBER:
414002425
ADMINISTRATOR/
DIRECTOR:		JACOBO, MARISELA A.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 440-1245
CITY:SAN MATEOSTATE: CAZIP CODE:
94401
CAPACITY: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 11DATE:
02/04/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:58 AM
MET WITH:Marisela A. JacoboTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On February 4, 2025, at approximately 12:00 p.m., Licensing Program Analyst (LPA) Zeynep Basak conducted an unannounced annual inspection, met the licensee, Marisela A. Jacobo, and explained the purpose of the inspection.

LPA observed the licensee, her mother, and an assistant supervising 11 children (2 infants, 3 toddlers, and 6 preschoolers). The licensee stated her mom was only helping today. LPA reviewed her file and found MMR record was not in the file. The licensee stated she might have taken it and will contact the provider to get a copy and provide it to the LPA by 2/7/2025.
The licensee complies with the licensing capacity during the time of inspection. The children’s roster had been reviewed and was found to be complete and up to date.

The licensee owns a three-bedroom home. The licensee stated that a total of five adults live in the home. LPA verified with the Guardian Roster that all present/live-in adults have criminal clearance. Per the licensee, the operational hours of the Child Care Home are Monday through Friday, from 7:00 a.m. to 5:30 p.m.

The daycare areas: Living room, dining room, family room, kitchen, bathroom#1, and backyard.
Off-limit areas: Bedroom #1, 2, 3, bathroom #2 and the garage.
According to the licensee, there have been no changes to the previously approved childcare areas and off-limits areas. LPA observed all off-limits areas to be securely barricaded and inaccessible to children in care.

LPA observed the home to be clean and in good repair with proper temperature and ventilation. LPA observed 3 working combo smoke detectors and carbon monoxide detectors, and a fully charged fire extinguisher in the size of 2A:10BC in the kitchen.
See page 2.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Zeynep Basak
LICENSING EVALUATOR SIGNATURE: DATE: 02/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/04/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
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: JACOBO, MARISELA A.
FACILITY NUMBER: 414002425
VISIT DATE: 02/04/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Page 2.
LPA observed the childcare home to have a functioning telephone and verified contact information. Per the licensee, there is no firearm/weapon in the home. The licensee stated that breakfast, lunch, morning and afternoon snacks were provided for children in addition to drinking water.

LPA and the licensee inspected the childcare areas for health and safety hazards. LPA observed the daycare area to be clean, with all outlets covered. LPA observed that all cleaning supplies and chemicals were properly stored and inaccessible to children. LPA observed the daycare area to be equipped with age-appropriate furniture, toys, books, and educational materials.

LPA observed mats and individual sheets in the daycare. The licensee verified that some children bring their sheets and blankets from home, while the licensee provides additional bedding for those who do not bring their own. Per the license, the facility currently has 2 infants, but they are almost 2 years old, and they sleep on a mat. LPA reminded the licensee of the safe sleep regulation that no toys, blankets, or other items hanging over or placed in cribs. The licensee was informed about maintaining a sleep log to check on infants every 15 minutes during naptime. The licensee acknowledged that no baby walkers, bouncers, or similar items are used during daycare hours.

LPA inspected the children’s bathroom and observed it to be clean and sanitary, with no chemicals within the children’s reach. LPA inspected the outdoor play area for health and safety hazards and observed sufficient toys and play materials in the backyard for children. LPA confirmed with the licensee that an isolation area is available in the living room for ill children while waiting for their guardians to arrive. The licensee confirmed that no children currently have allergies or require medication.
Per the licensee, emergency drills are conducted at least once every six months, and the latest drill was conducted on January 24, 2025.

LPA observed that all required forms and postings were displayed in the Child Care Home, including the License, Parent’s Rights Poster, and Floor Plan.

Per the licensee, the facility carries liability insurance for the daycare, and the copy was provided to LPA for placement in the physical file.
See page 3.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Zeynep Basak
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2025
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: JACOBO, MARISELA A.
FACILITY NUMBER: 414002425
VISIT DATE: 02/04/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Page 3
LPA reviewed the children’s files and found that three of the children did not have an immunization record in the file. The licensee contacted the parent to send the results, and LPA reviewed the record during the inspection. LPA observed that all other required records were in the file, including Emergency Cards and Parental Rights forms.
LPA reviewed the staff file and found that the licensee and the assistant have a valid CPR and First Aid certification expires in February 2026, and Mandated Reporter training that expires on 2/2026.

The licensee was reminded that all adults 18 years of age or older living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption as specified in Health and Safety Code Section 1596.871. This must occur prior to initial presence in a licensed Family Child Care Home. LPA informed the licensee that a civil penalty of $100 per person per day will be assessed for unqualified adults present for a maximum of five days. If this is a repeat violation, the penalty may increase to $500 per person per day after the fifth day.

LPA discussed the safe sleep regulations with the licensee and shared the Child Care Licensing Safe Sleep webpage located at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed the licensee about the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov. LPA recommended that the licensee register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed with the licensee. For additional information, LPA referred the licensee to PIN 22-02-CCP. LPA informed the licensee that when any IMS is provided, a Plan for Providing IMS must be submitted to the Department. Information regarding ADA compliance was also shared, including the toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY). A publication titled “Commonly Asked Questions about Child Care Centers and the ADA” is available at https://www.ada.gov/resources/child-care-centers/.

See page 4.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Zeynep Basak
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2025
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: JACOBO, MARISELA A.
FACILITY NUMBER: 414002425
VISIT DATE: 02/04/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Page 4.
To improve the quality and value of the inspection process, LPA informed the licensee that a survey may be sent to the email address on file. The licensee was encouraged to complete the survey and share her inspection experience. For additional information regarding the inspection process, the licensee was referred to the program website at https://www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

LPA also provided information about the MyChildCarePlan.org website, a consumer education resource that connects families with child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the inspection, the licensee confirmed that there are no registered sex offenders living in the facility. LPA completed the RSO profile in FAS.

A notice of site visit was provided and must remain posted for 30 days.

The exit interview was conducted, and the report was reviewed with the licensee, Marisela A. Jacobo.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Zeynep Basak
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2025
LIC809 (FAS) - (06/04)
Page: 4 of 4