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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414005048
Report Date: 10/14/2026
Date Signed: 10/14/2026 12:09:06 PM

Document Has Been Signed on 10/14/2026 12:09 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:TSAGAAN, SARANTUYAFACILITY NUMBER:
414005048
ADMINISTRATOR/
DIRECTOR:		TSAGAAN, SARANTUYAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 517-6919
CITY:SOUTH SAN FRANCISCOSTATE: CAZIP CODE:
94080
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
10/14/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:28 AM
MET WITH:Licensee, Sarantuya TsagaanTIME VISIT/
INSPECTION COMPLETED:
12:25 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 October 14th, 2026, at approximately 8:30AM, Licensing Program Analyst (LPA) Alvarado conducted an unannounced annual visit at the facility. LPA Alvarado met with Licensee Sarantuya Tsagaan(L1) and disclosed the purpose of the visit for today. Present in the Facility is Licensee supervising 6 Children, 4 infants and 2 Preschooler’s and assistant. (L1) is a large license and is operating within capacity limits and ratio during today’s inspection, as (L1) has assistant present. (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. Everyone in the household has fingerprint clearance and are associated to the facility as of today’s inspection.

Daycare area: Living Room, Dining Room, Room #1, bathroom (only for children use) on the second level, and the Backyard.
OFF limit area: Kitchen, Room #2, Room #3, and Garage

Facility hours of operation are Monday-Friday 7:30AM-5:30PM. LPA inspected the home for any health or safety hazards along with (L1) indoors and outdoors. LPA observed the home to be in clean and orderly condition. LPA observed age-appropriate toys and learning materials to be present. Furniture is age-appropriate and free of rough, loose, or sharp edges. Outlets were observed to be properly inaccessible. Chemicals, poisons and similar items were not observed and made inaccessible to children.

The home is equipped with a fully charged fire extinguisher. Facility has a combination smoke and carbon monoxide detector. There is a fireplace present in the facility that is properly barricaded and made inaccessible to children. (L1) stated, there are no firearms present in the facility.

Continued on Page 2...
Ali Zebila
Diana Alvarado
DATE: 10/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/14/2026
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 6
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)
Page: 2 of 6
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: TSAGAAN, SARANTUYA
FACILITY NUMBER: 414005048
VISIT DATE: 10/14/2026
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...
Breakfast, Lunch and Snack are provided by the Facility. (L1) also provide water as needed. (L1) provides sheets and blankets and washes them once a week. LPA conducted Children Record review, for the 6 children that are present. Children Records were observed to be complete including the Infant Sleeping Plan (LIC 9227) and sleep logs were made available for review. LPA reminded (L1) that sleep logs must be continued to be maintained for infants 0months up to 24 months.

LPA conducted two personnel record review for (L1) and assistant and (L1’s) Pediatric First Aid/CPR is current expiring 7/2027 and the Mandated Reporter Training is current Expiring 9/2027 LPA also reminded (L1) that (L1s) immunization's must also be maintained and made available for review. LPA explained to refer to the Entrance checklist for Family Child Care Homes (LIC 126) that was observed to be posted on the licensing board. Facility will be issued one Type B citation regarding Personnel Records, as present assistant is does not have a completed file. LPA reviewed facility documents and observed that the Facility license is posted, Notification of Parent Rights (PUB 394) also observed to be posted. LPA reminded that the Earthquake Preparedness (LIC 9148) must be made visible, as it was observed to be behind other documents on the licensing board. LPA reviewed the Emergency Disaster Plan, Verification of the Disaster and File Drills that have been maintained and documented, Last drill conducted was on September 17th, 2026. LPA also observe that (L1) has maintained the Facility Roster (LIC 9040) and was made available for review.

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.

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.

Continued on Page 3...
NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Diana Alvarado
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2026
LIC809 (FAS) - (06/04)
Page: 3 of 6
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: TSAGAAN, SARANTUYA
FACILITY NUMBER: 414005048
VISIT DATE: 10/14/2026
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...
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-andresources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for 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/.

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.

PIN 26-11-CCP was discussed with facility representative and a copy of PIN 26-11-CCP was provided.

During the exit interview, Licensee, Sarantuya Tsagaan 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 October 14th, 2026 under the California Code of Regulations, Title 22, Division 12, Chapter 1. Regarding Facility Administration.

Appeal Rights and A notice of site visit was provided to (L1) and must remain posted for 30 days.
Exit interview conducted and report was reviewed with the licensee, Sarantuya Tsagaan.
NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Diana Alvarado
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2026
LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 10/14/2026 12:09 PM - It Cannot Be Edited


Created By: Diana Alvarado On 10/14/2026 at 11:41 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: TSAGAAN, SARANTUYA
FACILITY NUMBER: 414005048

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/14/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.1(a)
Personnel Records
(a) Personnel records shall be maintained on each employee and shall contain the following information:

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 one out of one person as present assistant does not have a completed personnel record which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/13/2026
Plan of Correction
1
2
3
4
Based of interview with the Licensee and assistant, Assistant has partial Pediatric First Aid/CPR Completed online portion only. Assistant stated that the in-person version was completed and will reach out the training site for a updated proof of completion. Facility will ensure to refer to the Entrance Checklist for Family Child Care Home (LIC 126) to ensure that all required forms under the personnel records are to be put together and be completed including proof of the Tuberculosis for assistant. LPA will conduct a follow up inspection with the facility to ensure that files have been completed. Licensee will communicate with LPA and ensure to also send [roof to LPA by 11/13/2026 via email.
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: 10/14/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/14/2026


LIC809 (FAS) - (06/04)
Page: 5 of 6