414005100-4-6-2026-05-CC-DALO-DSVSAN-20260406134237

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414005100
Report Date: 04/06/2026
Date Signed: 04/06/2026 01:42:52 PM

Document Has Been Signed on 04/06/2026 01:42 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:	MONTECINOS, NORMA		FACILITY NUMBER:	414005100
ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 4	CENSUS: 4	DATE:	04/06/2026
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:49 AM
MET WITH:	Licensee, Norma Montecinos		TIME VISIT/ INSPECTION COMPLETED:	01:55 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 April 6, 2026, at approximately 9:50AM Licensing Program Analyst (LPA) Alvarado conducted an unannounced annual visit at the facility. LPA Alvarado met with Licensee Norma Montecinos(L1) and disclosed the purpose of the visit for today. LPA Alvarado observed Present in the Facility is (L1) supervising 4 children (1 Infant and 3 Preschoolers). Facility is a small license and is currently operating at capacity during today’s inspection. Everyone in the household has fingerprint clearance and is associated with the facility as of today’s inspection. DAY CARE AREAS are the living room, dining room, bathroom #1, bedroom #1, (garage for walk through to backyard Only), and backyard. OFF-LIMIT AREAS are bedroom #2, bedroom #3, bathroom #2, and garage. Off limit areas are made inaccessible with child proof safety gates and child safety locks. LPA along with (L1) inspected the home for any health or safety hazards indoors and outdoors. The home is clean and in orderly condition. Flooring of the home consists of wood and large rugs. The home is equipped with a fire extinguisher that’s a 3-A:40-B:C located in the living room. Facility has a smoke alarm and Carbon monoxide detector, that were tested and observed to be functioning during today’s inspection. (L1) also has an emergency backpack that was observed to have a complete First Aid Kit. Per (L1) the luggage below it is Emergency Food kit located near the entrance of the facility. Continued on Page 2...

NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Diana Alvarado
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2026

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 7

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 7

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: MONTECINOS, NORMA	FACILITY NUMBER: 414005100
	VISIT DATE: 04/06/2026

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...

Facility has a fireplace that was observed to be made inaccessible to children in care located in the living room. Facility has cubbies that are designated for children’s belongings in the entrance of the facility. Facility has all off limit areas properly barricaded and made inaccessible to children. Outdoor space was observed to have a large open area with patched artificial grass, LPA also observed wooden home and small play structures. Outdoor space has a fence that encloses the yard that is at least 4ft high. LPA suggested to (L1) to continue to monitor the bottom of the fence and ensure that loose gravel is removed or placed back in the dirt along the fence.

Facility hours of operation are Monday-Friday 8:00AM-5:00PM. LPA observed age-appropriate toys and learning materials to be present. Furniture is age-appropriate and free of rough, loose, or sharp edges. Wall outlets were observed to be child proof. Per (L1) Parents provide and pack Breakfast, Lunch and Snack from home. LPA reminded (L1) If food is brought from the children's homes, the container shall be labeled with the child's name and properly stored or refrigerated. LPA observed that one of the children’s lunchboxes from home did not have ice packs that contained packed food. (L1) stated that facility provides napping equipment such as mats and pack n plays. Per (L1) parents provided sheets and blankets from home and are sent home at the end of the week to be returned the following. LPA observed the children’s bathroom, which includes one sinks one toilet and one potty chair, to be functional during today’s inspection, children’s bathroom located next to the kitchen which is the main day care area and is only for child use. Also observed in the children’s bathroom was a changing table. Per (L1) there are no firearms present in the facility. All chemicals and Poisons are locked and made inaccessible to children. No pools, hot tubs, spas, fishponds or similar bodies of water observed on the property. (L1) also confirmed there were no bodies of water on property. (L1) was reminded that Baby-walkers, bouncers, jumpers and similar items will not be used for children in care and are not allowed.

LPA reviewed one personnel record where (L1) has Mandated Reporter Training that is current Expiring 11/2026 and has Current Pediatric First Aid/CPR Expiring 5/2027. 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.

Continued on Page 3...

NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Diana Alvarado
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2026

LIC809 (FAS) - (06/04)

Page: 3 of 7

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: MONTECINOS, NORMA	FACILITY NUMBER: 414005100
	VISIT DATE: 04/06/2026

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 reviewed four child’s records out of the four that were present, records were observed to be completed with required documents. Including 15-Minute Sleep Logs were observed to be maintained and the Individual infant sleeping Plan (LIC 9227) for infant in care.

LPA reviewed Facility Records and observed required documents posted and available for review. Facility has conducted and documented the Emergency Disaster Drills last one conducted was 3/18/2026. (L1) was reminded that the emergency drills must be continued to be conducted and documented once every six months. Entrance Checklist for Family Child Care Homes (LIC 126) was provided to (L1) for reference.

(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.

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.

Continued on Page 4...

NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Diana Alvarado
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2026

LIC809 (FAS) - (06/04)

Page: 4 of 7

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: MONTECINOS, NORMA	FACILITY NUMBER: 414005100
	VISIT DATE: 04/06/2026

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 4 Continued...

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/.

(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, Norma Montecinos 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.

Based on today's inspection April 6, 2026, no deficiencies were issued today during LPA's visit.

See LIC9102-TV for Technical Violation and Technical Assistance issued today regarding Physical Plant.

A notice of site visit was given and must remain posted for 30 days. Appeal Rights were provided too (L1).

Exit interview conducted and report was reviewed with the licensee, Norma Montecinos.

NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Diana Alvarado
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2026

LIC809 (FAS) - (06/04)

Page: 5 of 7