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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004793
Report Date: 11/17/2025
Date Signed: 11/17/2025 03:32:36 PM

Document Has Been Signed on 11/17/2025 03:32 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:COIMBRA, TALITA MIRELLEFACILITY NUMBER:
414004793
ADMINISTRATOR/
DIRECTOR:		COIMBRA, TALITA MIRELLEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 660-3032
CITY:SAN MATEOSTATE: CAZIP CODE:
94403
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 11DATE:
11/17/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Licensee, Talita Mirelle CoimbraTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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On 11/17/2025, at approximately 1:15PM, Licensing Program Analyst (LPA) Jonathan Tse conducted an unannounced annual visit at the facility. LPA met with Licensee, Talita Coimbra, and explained the purpose of the visit. Present during the visit was the Licensee, one helper, 4 infants, and 7 preschool age children. The facility is operating within staffing and ratio requirements on this day.

DAY CARE AREAS: Living Room, Bathroom #1 (located upstairs), and half of the Backyard.
OFF-LIMIT AREAS: Bedroom #1 (located on ground level), Bedroom #2, Bedroom #3, Bathroom #2, Kitchen, Dining Area (pass by only into the Backyard), Laundry Room, and half of the Backyard.

LPA and Licensee inspected the home for any health or safety hazards. The home is equipped with a fully charged fire extinguisher that is at least size 2A10BC. There is a carbon monoxide detector present. There is a fireplace located in the Living Room that has been barricaded to be inaccessible to children in care. Poisons, cleaning detergents, and other chemicals are stored inaccessible to children in care. Stairs are off-limits and kept inaccessible to children unless Bathroom #1 is in use. Off-limits areas are kept inaccessible with childproof gates.

There are age-appropriate toys and learning materials present. Furniture is age-appropriate and free of rough or sharp edges. There are cubbies available for children to use as storage. LPA observed children napping in pack-and-plays or cots. LPA advised that children should not nap on couches, and should use a cot instead. Licensee stated that she understood. Per Licensee, blankets and bedding are brought from home. The facility provides breakfast, lunch, and PM snack for children in care.
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NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Jonathan Tse
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/17/2025
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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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: COIMBRA, TALITA MIRELLE
FACILITY NUMBER: 414004793
VISIT DATE: 11/17/2025
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LPA advised that pack-and-plays shall be arranged such that there is a walkway between them. Licensee stated that she understood. There are pack-and-plays available for each infant who naps in one. Storage of medication was reviewed. Per Licensee, if there is a food allergy, she removes the item or allergen from her menu.

LPA observed the Backyard to be free of debris and other loose articles. The Backyard is enclosed by a fence that is at least four feet high. The area of the Backyard meant for childcare use is separated with a childproof gate. There are age-appropriate toys and equipment present. Shade is available for children through a tarp. There are no swimming pools or other similar bodies of water present. There are no firearms or weapons stored in the home.

LPA reviewed 2 staff files, 5 children’s files, and facility records. Licensee’s Pediatric First Aid/CPR training is current and expires 5/2026. Licensee’s Mandated Reporter training is current and expires 12/2025. LPA advised that Mandated Reporter training be completed before 12/2025. Licensee stated that she understood.

Children’s files were reviewed and observed to contain Emergency Identification and Information (LIC700) and admission agreements. Sleep logs were reviewed. LPA advised that sleep logs are part of a child’s file and all completed sleep logs are to be maintained in each child’s file. Children’s files are required to be kept and available for review for three years after a child’s last day at the facility. Licensee stated that she understood.

All required postings were observed to be posted and accessible for review in the Living Room. The facility last conducted an emergency drill in November 2025. Drills are logged and documented.

Licensee 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.

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NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Jonathan Tse
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2025
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: COIMBRA, TALITA MIRELLE
FACILITY NUMBER: 414004793
VISIT DATE: 11/17/2025
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LPA discussed the safe sleep regulations with licensee 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.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514- 0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are 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, the Licensee, Talita Coimbra, 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 on 11/17/2025. See LIC9102-TV for technical violations issued today regarding physical plant and staff records. See LIC9102-TA for technical assistance provided today regarding children’s records and personal rights. Appeal rights were provided and explained.
A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee, Talita Coimbra.
NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Jonathan Tse
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2025
LIC809 (FAS) - (06/04)
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