414002885-5-5-2026-05-CC-DALO-DTSRVT-20260505132203

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414002885
Report Date: 05/05/2026
Date Signed: 05/05/2026 01:22:27 PM

Document Has Been Signed on 05/05/2026 01:22 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:	SANTIAGO, ANA BERTHA		FACILITY NUMBER:	414002885
ADMINISTRATOR/ DIRECTOR:	SANTIAGO, ANA BERTHA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 728-7317
CITY:	MOSS BEACH	STATE: CA	ZIP CODE:	94038
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 6	CENSUS: 5	DATE:	05/05/2026
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:58 AM
MET WITH:	Licensee, Ana Bertha Santiago		TIME VISIT/ INSPECTION COMPLETED:	01:40 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 5/5/2026, at approximately 9:15AM, Licensing Program Analyst (LPA) Alvarado conducted an unannounced annual visit at the facility. LPA Alvarado met with Licensee Ana Bertha Santiago(L1) and disclosed the purpose of the visit for today. Upon arrival of the Facility (L1) disclosed that she has two relatives who do not reside in the home that are present who are visiting and that a Health Physician was also going to arrive, shortly after. Present in the Facility is Licensee supervising 5 children (4 Infants and 1 Preschool age Children).The Facility is a large license and is not operating within capacity limits and ratio during today’s inspection. (L1) was reminded that if no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in 102416.5 Staffing Ratio and Capacity. Daycare area: Living Room, Kitchen, Bedroom 1, Bedroom 3, Bathroom 1 (Located in Bedroom 1), and the Outdoor Play yard. OFF limit area: Bedroom 2, Bathroom 2, and Driveway. LPA inspected the home for any health or safety hazards with (L1). During the Inspection walkthrough LPA observed an Infant in a Stroller and LPA removed Immediately, Infant was not sleeping. LPA reminded (L1), that Car seats and strollers are only a form of transportation. LPA observed the home to be in clean and orderly condition. The home is equipped with a fully charged fire extinguisher, that is located on the wall. Facility has a smoke Detector and Carbon monoxide detector that were observed to be functioning during today’s inspection. Per (L1) there are no firearms present in the facility. All chemicals and Poisons are locked being made inaccessible. The home has no pools or similar bodies of water on property. LPA reminded (L1) that baby walkers, bouncers, jumpers and any other similar items are to not be used for children in care. (L1) also confirmed of no similar bodies of water on property. Continued on Page 2..

NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Diana Alvarado
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/05/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2026

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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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: 05/05/2026

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Facility hours of operation are Monday-Friday 7:30AM-4:30PM. Per (L1) also goes by family needs. LPA observed age-appropriate toys and learning materials to be present. Furniture is age-appropriate and free of rough, loose, or sharp edges. Per (L1) facility provides Breakfast, Lunch, and Snack. (L1) also stated that the facility provides napping equipment. LPA reminded (L1) that there shall be at least one crib per infant. (L1) stated that the facility washes weekly or as needed. Phone number listed for (L1) is current. LPA observed a First Aid Kit to be available and complete.

LPA reviewed one personnel record, (L1) has current Mandated Reporter Training that Expiries 11/2027, (L1) has Current Pediatric First Aid/CPR that expires 2/2028. LPA reminded (L1) that Pediatric First Aid/CPR and Mandated Reporter Training need to be renewed every two years and for all assistants who are providing care to children. Required Immunizations were also observed to be maintained on file for (L1).

LPA reviewed 5 children’s records out of the 5 that were present, that were observed to have completed with required documents. LPA reminded (L1) of a few forms that were missing, LIC 9227 were observed to be on file for infants and LPA was able to observed that (L1) has been maintaining 15 Min sleep logs for infants 24Months and under.

LPA during file reviews observed that the facility was overcapacity. Facility has Four Infants and 1 Preschooler.

LPA reviewed Facility Records and observed partial required documents posted and available for review. Reminding (L1) of a few that were missing and provided during today’s inspection. Facility has conducted and documented the Emergency Disaster Drills recently, Last one Documented was for 2/12/2026. LPA reminded (L1) that emergency drills must be continued to be conducted and documented once every six months. LPA provided (L1) with the Entrance Checklist for Family Child Care Homes (LIC 126) for reference regrinding required items to be made available for inspection by the licensee or facility representative.

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NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Diana Alvarado
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/05/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2026

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: SANTIAGO, ANA BERTHA	FACILITY NUMBER: 414002885
	VISIT DATE: 05/05/2026

NARRATIVE

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(L1) was reminded that all adults 18 and over living or working in the home, 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 licensed Family Child Care Home. 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.

During todays inspection present were (L1) relatives who do not live in the facility or provide any care. LPA reminded (L1) that if relatives are not fingerprinted, they may not provided any care for any children present.

LPA discussed the safe sleep regulations with (L1) and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed licensee [or facility representative] of the importance of checking for and removing any recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

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/.

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NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Diana Alvarado
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/05/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2026

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: SANTIAGO, ANA BERTHA	FACILITY NUMBER: 414002885
	VISIT DATE: 05/05/2026

NARRATIVE

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(L1) 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, the Licensee Ana Bertha Santiago, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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.

LPA Diana Alvarado informed licensee Ana Bertha Santiago that this report dated 5/5/2026 document’s 1 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 Diana Alvarado informed the licensee, Ana Bertha Santiago to provide a copy of this licensing report dated 5/5/2026 that documents any Type A citation 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.

See LIC 809-D for deficiencies being cited today on 5/5/2026 under the California Code of Regulations, Title 22, Division 12, Chapter 1. Regarding Staffing Ratio and Capacity, Physical Plant and Records.

See LIC9102-TA for Technical Violations regarding Care and Supervision and Facility Administration.

A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with the licensee, Ana Bertha Santiago.

NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Diana Alvarado
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/05/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 05/05/2026 01:22 PM - It Cannot Be Edited

Created By: Diana Alvarado On 05/05/2026 at 12:17 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: 05/05/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

102416.5(b)(2)

Staffing Ratio and Capacity

(b) For a Small Family Child Care Home, the maximum number of children for whom care may be provided at any one time, including children under age 10 who reside at the licensee's home, shall be one of the following: (2) Six children, no more than three of whom may be infants; or 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 where the Licensee is overcapacity, Licensee has four infants in care and 1 preschooler which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 05/06/2026
	Plan of Correction
1 2 3 4	Licensee will create a schedule, where it will reflect the days that children will be present in ensuring that the Licensee does not have more than three infants overlapping in the event that additional preschoolers will be in care. This schedule will also be posted visibly as a reminder for the Licensee to ensure that the infants are not all present during the same time, as Licensee stated some children come on certain days. Licensee will also send this schedule to LPA Alvarado via email or text message by 5/6/2026. LPA will also conduct a follow-up inspection to ensure that the Facility is also no longer overcapacity.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: 05/05/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 05/05/2026 01:22 PM - It Cannot Be Edited

Created By: Diana Alvarado On 05/05/2026 at 12:17 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: 05/05/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(a)

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. 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 where the Licensee has four infant in care and LPA was only able to see two cribs present which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/11/2026
	Plan of Correction
1 2 3 4	Licesnee will ensure to have at least one additional crib, as the licensee has one infant who is tall enough to climb out of the crib. LPA reminded the licensee that there should be at least one crib per infant in care. Licensee will submit a photos of additional crib or pack n play to LPA Alvarado either by email or text message by 5/11/2026

Type B

Section Cited

CCR

102418(a)

Immunizations

(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000. 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 where the Licensee has two out of the five children present who do not have proof of immunizations which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/15/2026
	Plan of Correction
1 2 3 4	Licesnee will ensure to obtain proof of immunizations from two families, as two currently enrolled children do not have proof of immunization. Licensee will submit proof of Immunizations for Infant Dariel and Faith by 5/15/2026 either via email or text message to LPA Alvarado.

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: 05/05/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2026

LIC809 (FAS) - (06/04)

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