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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004115
Report Date: 03/25/2025
Date Signed: 04/08/2025 03:26:43 PM

Document Has Been Signed on 04/08/2025 03:26 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:PAPILLON PRESCHOOL MANAGED BY BRIGHT HORIZONS INFFACILITY NUMBER:
414004115
ADMINISTRATOR/
DIRECTOR:		ROWENA DE LOS ANGELESFACILITY TYPE:
830
ADDRESS:1311 SO. EL CAMINO REALTELEPHONE:
(650) 340-7241
CITY:SAN MATEOSTATE: CAZIP CODE:
94402
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 13DATE:
03/25/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Courtney Gromowski, Rowena De Los AngelesTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
NARRATIVE
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On 3/25/2025 at 9:00AM., Licensing Program Analysts, (LPA) Luis Gomez and Ruhi Wadhwa met with Assistant Director, Courtney Gromowski. Director, Rowena De Los Angeles arrived during inspection. Purpose of the inspection was explained and is for an Unannounced, Annual/ Random inspection. Facility is a licensed to provide infant care, and is a combination center with preschool program on site. Present was the director and 7 staff supervising 13 children. Present staff have criminal record clearances of file. LPA reminded facility to ensure children present are signed in by guardians. Advisory Note: Technical Violation (LIC9102TV) was issued.

The infant program utilizes two rooms: Caterpillar (1-1.5 years old), Cocoon (0-1 years old), and one, shared, outdoor play yard. Waiver for rational use outdoor space was observed posted in the lobby. The days and hours of operation are Monday- Friday, 8:00AM- 6:00PM. LPAs inspected facility, indoors and outdoors, for health and safety hazards.

At 9:15AM., LPAs observed the following: Infant classrooms were neat, with age-appropriate playthings available for the children. Floor and ground surfaces were free of obstructions or possible hazards. LPA observed storage cubbies of children’s belongings.

At 9:22AM., Based on observation, LPAs confirmed accessible toys with chipped paint in the cocoon classroom. Defected items were removed from classroom during inspection. Advisory Note: Technical Violation (LIC9102TV) was issued.

At 9:25AM., Based on observation, LPAs confirmed dirt and stained padded climbing equipment in cocoon classroom.

Accessible furniture inspected was in good repair. LPAs observed children tables and chairs, scaled to the appropriate size. Feeding chairs inspected were equipped with a stable (wide base), with removable table component. Diaper changing tables were available for staff, within arm’s reach of a sink. All trash bins used for solid waste have been covered. (REFER TO 809C, FOR CONT.)

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Luis Gomez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/25/2025
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 04/08/2025 03:26 PM - It Cannot Be Edited


Created By: Luis Gomez On 03/25/2025 at 11:30 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: PAPILLON PRESCHOOL MANAGED BY BRIGHT HORIZONS INF
FACILITY NUMBER: 414004115

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/25/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101239(n)
Fixtures, Furniture, Equipment and Supplies
(n) Furniture and equipment shall be maintained in good condition, free of sharp, loose or pointed parts.

This requirement is not met as evidenced by:
Deficient Practice Statement
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At 9:25AM., Based on observation, LPAs confirmed dirt and stained padded climbing equipment in cocoon classroom. This poses a potential health and safety risk to children in care.
POC Due Date: 04/01/2025
Plan of Correction
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Director will clean/ or replace stained padded equipment in infant classroom by the due date: 4/1/2025.
Proof of correction will be submitted to the Department via email.
Type B
Section Cited
CCR
101429(a)(2)(C)(3)
Responsibility for Providing Care and Supervision for Infants
(C) Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: (3) Time of each 15-minute check

This requirement is not met as evidenced by:
Deficient Practice Statement
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At 10:35AM., Based on record review, LPAs confirmed documentation for infant napping conditions are being logged after the required 15 minutes review. This poses a potential health and safety risk to children in care.
POC Due Date: 04/01/2025
Plan of Correction
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Director will submit plan to ensure 15 minute review for napping infants in care is properly logged by the due date: 4/1/2025.
Proof of correction will be submitted to the Department via email.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Marie Rodriguez
NAME OF LICENSING PROGRAM MANAGER:
Luis Gomez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 03/25/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/25/2025


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: PAPILLON PRESCHOOL MANAGED BY BRIGHT HORIZONS INF
FACILITY NUMBER: 414004115
VISIT DATE: 03/25/2025
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Food preparation area in classrooms have a separate sink. Labeled Infant bottles and cups were correctly stored in the refrigerator. Per director, bottles are taken home by families daily to be cleaned, refilled and returned.

For napping services, LPAs observed several infant cribs located in a separated napping area. Each infant crib has a tight-fitted sheet, properly sized mattress and was labeled. Cribs have visibility on all sides for constant staff supervision. Per director, napping sheets are changed daily and washed weekly. Facility had acceptable ventilation and lighting. Detergents, cleaning supplies, and sharp or hazardous objects have been made inaccessible to children. Facility had testable carbon monoxide detector and fully charged fire extinguisher, 2A10BC.

LPAs inspected the infant outdoor play area. LPA observed area was completely enclosed, with turf padding installed for added safety. Sandbox has been properly covered and was free of hazardous items.

Per director, for water services, refillable cups and pitchers are available for children to drink as they wish.

At 10:30AM., LPAs reviewed facility records including 4 children’s files and 7 personnel files. Staff files contained the: Teacher Qualifications; Personnel Record (LIC501); and Health Screening (LIC503).

LPAs reminded director to ensure staff proof of immunization are stored in facility files. Advisory Note: Technical Violation (LIC9102TV) was issued.

Children’s files were reviewed and included the: Consent for Medical Treatment (LIC627), Identification of Emergency Information (LIC700), Immunization Records; Individual Infant Sleeping Plan (LIC9227); and Admissions Agreement. (REFER TO 809C, FOR CONT.)

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Luis Gomez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2025
LIC809 (FAS) - (06/04)
Page: 7 of 8
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: PAPILLON PRESCHOOL MANAGED BY BRIGHT HORIZONS INF
FACILITY NUMBER: 414004115
VISIT DATE: 03/25/2025
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At 10:35AM., Based on record review, LPAs confirmed documentation for infant napping conditions are being logged after the required 15 minutes review.

Staff’s CPR/ 1st Aid Certification was current, expiring: 4/14/2026.

Facility emergency disaster drill (Fire and Earthquake) was completed on: 1/31/2025 and 10/16/2024.



Required posting were observed in the facility including the: Facility License; Emergency Disaster Plan (LIC610); Seat Beat Safety Laws; Notification of Parent’s Rights (LIC995A); Lunch Menu (March, 2025); and Personal Rights.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manuel – Regulations Interpretations and Procedures for Child Care Centers Section 101173 and 101226. When an IMS is provided, an updated Plan of Operations that includes IMS must be submitted to the Department. Following information regarding ADA was provided: US Department of Justice (USDOJ) toll- free ADA information line at (800) 514- 0382 (TTY) and link to publications: Commonly asked questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm



Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in Child Care Center. A civil penalty of $100.00 minimum/ day up to $500.00 maximum per day/per person will be assessment if this regulation is violated.

LPAs discussed safe sleep regulations with the director and discussed Child Care Licensing Safe Sleep webpage at: http://www.cdss.ca.gov/inforesource/child-care-licensing/public-information-and-resouce/safe-sleep as an additional resource. LPA also informed director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at: http://www.cpsc.gov/ and recommend they register all infant devices with the CPSC to be notified of any recalls on their purchased requirement.

Based on today's inspection, deficiencies were cited in the areas evaluated according to the Title 22 Division 12, Chap. 1 Ca. Code of Regulations. Exit interview and report was discussed with Director, Rowena De Los Angeles. Director's signature of this form acknowledges receipt of these documents.

This report and rights to comment were discussed. This report must be available in the facility for public review. Notice was given and must remain posted for 30 days. Facility was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Luis Gomez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2025
LIC809 (FAS) - (06/04)
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