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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002885
Report Date: 01/22/2025
Date Signed: 01/22/2025 02:01:52 PM

Document Has Been Signed on 01/22/2025 02:01 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:SANTIAGO, ANA BERTHAFACILITY NUMBER:
414002885
ADMINISTRATOR/
DIRECTOR:		SANTIAGO, ANA BERTHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 728-7317
CITY:MOSS BEACHSTATE: CAZIP CODE:
94038
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
01/22/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Ana Bertha SantiagoTIME VISIT/
INSPECTION COMPLETED:
02:20 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 1/22/2025, at approximately 9:00AM, Licensing Program Analyst (LPA) Alvarado conducted an unannounced annual visit at the facility. LPA Alvarado arrived at the facility as a parent was also dropping off a child. LPA Alvarado met with Licensee Ana Bertha Santiago(L1) and disclosed the purpose of the visit for today. Present in the Facility is Licensee supervising 2 Infants and 1 Preschool age Child. Everyone in the household has fingerprint clearance and are associated to the facility.

Daycare area: Living Room, Kitchen, Bedroom 1, Bedroom 3, Two Bathrooms and the Outdoor Play yard.
OFF limit area: Bedroom 2 and Driveway.

LPA inspected the home for any health or safety hazards with (L1) . During the Inspection walkthrough at 9:20AM LPA observed a crib with a pillow and the crib with a stacked mattress. LPA reminded (L1) in regard to Safe sleep, cribs shall be free of loose objects and articles. LPA observed (L1) removed the pillow and second mattress out of the crib and made it inaccessible. At 9:28AM LPA observed a sleep sack and LPA spoke to (L1) and advised (L1) that sleep sacks are not allowed. LPA observed (L1) remove the sleep sack. Safe Sleep Regulations were discussed. LPA observed the home to be in clean and orderly condition. The home is equipped with a fully charged fire extinguisher. Facility has a smoke Detector and Carbon monoxide detector. Per (L1) there are no firearms present in the facility. All chemicals and Poisons are locked, on a high shelf and made inaccessible to children. The home has no pools or similar bodies of water in the home. Licensee was reminded that baby walkers, bouncers, jumpers and any other similar items are to not be used for children in care.

Continued on Page 2..
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Diana Alvarado
LICENSING EVALUATOR SIGNATURE: DATE: 12/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/13/2024
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 9
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: SANTIAGO, ANA BERTHA
FACILITY NUMBER: 414002885
VISIT DATE: 01/22/2025
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 Continued...

Facility hours of operation are Monday-Friday 7:30AM-4:30PM. LPA observed age-appropriate toys and learning materials to be present. LPA observed cubbies for children belongings. Furniture is age-appropriate and free of rough, loose, or sharp edges. Licensee provides Breakfast, Lunch, and Snack. Licensee washes children blankets once a week per (L1) on fridays.

(L1) uses their cell phone as the facility’s primary telephone and licensee also has a landline. Phone number listed for (L1) is current. LPA reviewed 3 children’s record and advised on some of the missing forms. Licensee has a completed Mandated reporter training that is approved by the Department which expires 10/2026. Licensee’s Pediatric CPR/First Aid certification expires 6/2025. Licensee was reminded that Mandated Reporter Training and CPR/First Aid must be renews every two years.

All required postings, such as the facility license and Notification of Parents’ Rights have been placed in a prominent area for parents or authorized representatives to review. Licensee last conducted an Emergency Drill on 2/8/24 and was reminded that Fire and Emergency Drills must be conducted at least once every 6 months and properly log them.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Continued on Page 3...
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Diana Alvarado
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2025
LIC809 (FAS) - (06/04)
Page: 2 of 9
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: SANTIAGO, ANA BERTHA
FACILITY NUMBER: 414002885
VISIT DATE: 01/22/2025
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 Continued...

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing 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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the
ADA, available at: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

See LIC 809-D for deficiencies being cited today on 1/22/25 under the California Code of Regulations, Title 22, Division 12, Chapter 1. regarding infant safe sleep.

See LIC9102-TV for technical violation issued today regarding Operation of A Family Child Care Home, Immunizations, and Childs Records.
See Technical Advisory in regard to Operation of a Family Child Care Home.

Appeal rights were given and explained to the Licensee. A notice of site visit was given and must remain posted for 30 days. Licensee was reminded that a Notice of Site visit (LIC 9213) must be posted for 30 consecutive days during the hours of operation after each site visit by a licensing representative Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview conducted and report was reviewed with the licensee, Ana Bertha Santiago.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Diana Alvarado
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2025
LIC809 (FAS) - (06/04)
Page: 3 of 9
Document Has Been Signed on 01/22/2025 02:01 PM - It Cannot Be Edited


Created By: Diana Alvarado On 01/22/2025 at 12:21 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: SANTIAGO, ANA BERTHA
FACILITY NUMBER: 414002885

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/22/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(a)(4)
Infant Safe Sleep
(a) There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. (4) Mattresses shall be made specifically for the size crib or play yard in which they are placed.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and interview, the licensee did not comply with the section cited above in one out of one object which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/22/2025
Plan of Correction
1
2
3
4
Licensee removed the second mattress from the crib and make it inaccessible.
Type B
Section Cited
CCR
102425(b)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and interview, the licensee did not comply with the section cited above in one out of one object which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/22/2025
Plan of Correction
1
2
3
4
Licensee removed the pillow from the crib and make it inaccessible.
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:Ali Zebila
LICENSING EVALUATOR NAME:Diana Alvarado
LICENSING EVALUATOR SIGNATURE:
DATE: 01/22/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/22/2025


LIC809 (FAS) - (06/04)
Page: 4 of 9
Document Has Been Signed on 01/22/2025 02:01 PM - It Cannot Be Edited


Created By: Diana Alvarado On 01/22/2025 at 12:21 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: SANTIAGO, ANA BERTHA
FACILITY NUMBER: 414002885

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/22/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(f)
Infant Safe Sleep
An infant shall not be swaddled while in care.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and interview, the licensee did not comply with the section cited above in one out of one object which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/22/2025
Plan of Correction
1
2
3
4
Licensee will removed the sleep sack from the facility.
Type B
Section Cited
CCR
102425(j)(1)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview and record review, the licensee did not comply with the section cited above in two out of two persons which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/31/2025
Plan of Correction
1
2
3
4
Per licensee, licensee will document the infant safe sleep in a notebook and properly log it with all required information. Licesnee will submitt a photo to LPA Alvarado via email to verify that the infant safe sleep will be documented while in care.
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:Ali Zebila
LICENSING EVALUATOR NAME:Diana Alvarado
LICENSING EVALUATOR SIGNATURE:
DATE: 01/22/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/22/2025


LIC809 (FAS) - (06/04)
Page: 5 of 9