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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002998
Report Date: 03/26/2026
Date Signed: 04/09/2026 01:38:11 PM

Document Has Been Signed on 04/09/2026 01:38 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:JIMENEZ, EVELYN P.FACILITY NUMBER:
414002998
ADMINISTRATOR/
DIRECTOR:		JIMENEZ, EVELYN P.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 804-5474
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94061
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
03/26/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:40 AM
MET WITH:Evelyn JimenezTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On March 26, 2026, at approximately 8:40 am, Licensing Program Analyst (LPA) Maria Olguin-Leon met with licensee, Evelyn Jimenez, to conduct an unannounced annual inspection. The purpose of the inspection visit was explained. Present in the home today was licensee, licensee’s spouse, assistant, licensee’s two minor children and 2 daycare children (1 infant and 3 preschool age). All adults working and living in the home have criminal background clearances and are associated with facility. Facility is in compliance with ratio capacity requirements. Facility operates Monday – Friday from 8:00 am to 5:00 pm. Daycare children are dropped off at back door entrance of home, which is accessible through left side gate.

LPA observed Childcare License, Emergency Disaster Plan (LIC610A), Earthquake Preparedness checklist and Parent's rights posted on office wall next to back door entrance. Posting are easily accessible for parent to view. Last emergency drill was conducted on January 30, 2026, and is properly documented with date and time drill was conducted. Licensee owns a pet dog, which is kept away from children. LPA reviewed pet dog vaccinations.

Emergency pull down fire alarm and fully charged fire extinguisher are in office area and easily accessible. Licensee maintains a fully stocked first aid kit. There are several dual smoke/carbon monoxide detectors in home. Detectors were not tested during today’s visit, due to sleeping infant. LPA reminded Licensee to test detectors to ensure detectors are in working properly. Licensee maintains a cell phone service on the premises. Per licensee, there are no weapons or firearms in the home.

LPA inspected the indoors and outdoors of home for health and safety hazards. LPA observed home to be free of defects or conditions that might endanger a child. Home is a one-story dwelling with 3 bedrooms and 2 bathrooms. Daycare areas are Living room, dining room, bedroom 1 & 2 are for napping, bedroom 3 (main playroom), office, backdoor entrance foyer, hallway, bathrooms 1 & 2, and backyard/right side yard. Off-limit areas: detached garage. Isolation area: Sick children will be isolated in living room and away from other children. The home has proper heating, lighting and ventilation to provide safety and comfort. LPA observed child-size furniture, toys storage cubbies, books, learning material and other age-appropriate toys, all in good condition.

Cont. page 2...
NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Maria Olguin-Leon
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/26/2026
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: JIMENEZ, EVELYN P.
FACILITY NUMBER: 414002998
VISIT DATE: 03/26/2026
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LPA observed childproof gates at entrances into kitchen and a childproof gate in between office and backdoor entrance foyer. All electrical outlets are properly secured with childproof covers or barricaded with furniture. LPA observed furniture to have corner protectors. Cabinets in home are secured with childproof locks. LPA observed rugs in home to absorb and cushion falls.

Bathroom was clean and cabinets were secured with childproof locks and latches. LPA observed children’s potty-training toilet seat cover and potty chairs for potty training purposes. A changing table with a padded changing mat is located in office. LPA observed children’s diapering supplies are stored underneath changing table in storage cubbies. Cleaning supplies and other potentially harmful items are stored inaccessible to children and behind child proof cabinets.

LPA observed cribs and a playpen in bedroom #2. Mattresses are firm and covered with tight fitting sheets. Sleeping logs for infants under 24 months old are maintained and up to date. Parents provide sheets for cribs/playpens and sheets are sent home weekly for laundering.

Backyard/side yard is enclosed and surrounded by a 5 ft wood fence and a 2 ft gate with a lock. The left side of yard is used for walking through to back door entrance to drop off children. LPA observed ride-on toys, small slide play structures, sand box table, playhouse and other age-appropriate toys, all in good condition. Flooring in backyard is artificial grass to cushion falls. Backyard is equipped with canopies and a sunshade to provide shade for children in care. LPA did not observe any pool, spas, or other bodies of water. LPA reminded licensee when water table is in use to provide 100% supervision and empty water table after each use.

Licensee provides a meal service for children in care, which includes breakfast, lunch and two snacks. LPA reminded licensee that any food brought from home must be labeled and stored properly. LPA observed booster seats attached to chairs for children to sit and eat in kitchen. Kitchen was clean and food properly stored to prevent spoilage or contamination. Stove knobs were observed to have childproof knobs and kitchen cabinets are secured with child safety latches.

Cont. page 3...
NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Maria Olguin-Leon
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2026
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: JIMENEZ, EVELYN P.
FACILITY NUMBER: 414002998
VISIT DATE: 03/26/2026
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LPA reviewed 3 children’s files and 1 assistant file; all files were complete. Children’s roster was reviewed and is up to date. Licensee’s CPR/FA expiration date is 9/2027 and licensee’s Mandated reporter ex. 03/2027.

Licensee Evelyn Jimenez 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.

LPAs discussed the safe sleep regulations with licensee Evelyn Jimenez and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/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.

As of January 1, 2018, all staff must complete Mandated Reporter Training every two years. LPA reminded licensee about Mandated Reporter training available www.mandatedreporterca.com

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: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Maria Olguin-Leon
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2026
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: JIMENEZ, EVELYN P.
FACILITY NUMBER: 414002998
VISIT DATE: 03/26/2026
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Licensee Evelyn Jimenez 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.

Licensee was reminded about the Provider Information Notices (PINs) on the CCLD website. Licensee was informed that as of September 1, 2016, a person may not be employed or volunteer at a childcare facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662. LPA reviewed AB 1207 with the Licensee.

During the exit interview, the Licensee Evelyn Jimenez, 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.

No deficiencies were cited during today’s visit, under CCR, Title 22, Division 12.

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

Exit interview conducted and report was reviewed with the licensee, Evelyn Jimenez.
NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Maria Olguin-Leon
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2026
LIC809 (FAS) - (06/04)
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