414005167-10-16-2025-05-CC-JTSE-DMHTRM-20251016145745

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414005167
Report Date: 10/16/2025
Date Signed: 10/16/2025 02:58:41 PM

Document Has Been Signed on 10/16/2025 02:58 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:	REYES, MARISELA		FACILITY NUMBER:	414005167
ADMINISTRATOR/ DIRECTOR:	REYES, MARISELA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 758-8871
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94403
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 5	DATE:	10/16/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:00 AM
MET WITH:	Licensee, Marisela Reyes		TIME VISIT/ INSPECTION COMPLETED:	03:15 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 10/16/2025, at approximately 10:00AM, Licensing Program Analysts (LPAs) Jonathan Tse and Melissa Zaragoza (certified Spanish bilingual) conducted an unannounced annual visit at the facility. LPAs met with Licensee, Marisela Reyes, and explained the purpose of the visit. Present during the visit was the Licensee, three preschool-age children, and one infant. One preschool age child arrived at the facility at approximately 1:00PM. The facility is operating within staffing and ratio requirements on this day. Daycare Areas: Living Room, Bathroom, Enclosed Patio, and Backyard. Off-limits Areas: Bedroom #1, Bedroom #2, Bedroom #3, Bathroom #2 (located in Bedroom #1), Kitchen, and Garage. During the visit, Licensee informed LPAs that the previously licensed Bedroom was no longer used for daycare purposes. Licensee requested that it be taken off the listed daycare areas. Bedroom #3 has been added to the off-limit areas effective 10/16/2025. LPAs inspected the home for any health or safety hazards. The home is equipped with 2 fully charged 2A10BC fire extinguishers. There is a combination smoke and carbon monoxide detector present in the Living Room. There is a fireplace in the Living Room that has been barricaded to be inaccessible. Poisons, cleaning detergents, and other chemicals are stored inaccessible to children in care. Outlets are covered or blocked with furniture when not in use. LPAs observed there to be age-appropriate toys and learning materials present. Furniture was observed to be free of rough or sharp edges. Children have access to cubbies or hooks to store their belongings. Water bottles are brought from home and labeled with each child’s name. Continued on Page Two

NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Jonathan Tse
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2025

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: REYES, MARISELA	FACILITY NUMBER: 414005167
	VISIT DATE: 10/16/2025

NARRATIVE

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Per Licensee, the facility provides snacks, lunch, and dinner for children in care. LPAs observed there to be 2 cribs available for napping infants. There are cots available for preschool age children to nap on.

Upon entry to the Enclosed Patio, LPAs observed an infant to be napping in a crib with a sleep sack on, a pacifier with a toy attached to it, a bottle next to the infant, and stained sheets. Licensee removed all loose objects and the sleep sack immediately. The sheets were changed, and the infant was moved to a crib that had a tight-fitting sheet that overlapped the underside of the mattress. LPAs discussed infant safe sleep with Licensee. Sleep sacks are considered to be swaddling devices and are not allowed to be used in licensed Family Child Care Homes.

LPAs observed the Backyard to not be free of debris or other loose materials upon initial inspection. The neighboring yard has an apple tree with branches hanging over the facility’s Backyard. LPA observed apples to have fallen and been stepped on in the Backyard. LPAs advised that Licensee sweep the Backyard to ensure that all fallen apples have been picked up. Licensee stated that they understood.

LPAs observed that the door that leads to the Garage from the Backyard was open. The door is equipped with a childproof cover. LPAs advised that the door must remain closed while children are outside.

There is a cooler present that is not secured or locked. Licensee stated that they would use the cooler to store children’s backpacks. LPAs advised that the cooler lid may cause injury to children’s fingers. Licensee stated that they understood and moved the cooler from the Backyard to the Garage during the visit.

LPAs advised that a lock be kept on the shed in the Backyard to ensure that children do not enter. LPAs observed luggage and children’s toys to be stored and stacked up to the height of the door of the shed. LPAs advised that children should not be allowed entry to the shed to prevent risk of injury. Licensee stated that they understood.

There is a broken tarp present in the Backyard. A disassembled metal airplane structure is kept underneath the deck but is not covered to be inaccessible to children. LPAs observed a grill to be stored behind the shed but is not barricaded. Licensee stated that they would remove and dispose of all three objects.
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NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Jonathan Tse
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2025

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: REYES, MARISELA	FACILITY NUMBER: 414005167
	VISIT DATE: 10/16/2025

NARRATIVE

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LPAs observed that a power meter was obstructed by a wooden box. The wooden box had children’s toys and play equipment attached to it. LPAs advised that the wooden box should not have toys or other play equipment attached due to it potentially being able to be tipped over by use. Licensee stated that they understood and stated that they would remove all play equipment from the box.

LPAs advised that exposed piping and wiring shall be obstructed from children in care. Childproof gates or fencing may be used to block children from having access. There is an entrance to the crawl space of the home in the Backyard. LPAs observed that the cover to the crawl space was movable with one hand. LPAs advised that the entrance to the crawl space be blocked with childproof gates with the cover still in place. Licensee stated that they understood.

LPAs reviewed 2 staff files, 4 children’s files, and facility records. Licensee’s Pediatric First Aid/CPR is current and expires 5/2026. Licensee’s Mandated Reporter training is current and expires 6/2027. Children’s immunization records are present. LPAs advised that CDPH286 (California Pre-Kindergarten and School Immunization Record) be filled out and updated as needed. LPAs advised that Notification of Parents’ Rights (LIC995A) are to be kept by parents and the bottom portion where parents sign remains in the child’s file. LPAs confirmed that infant sleep logs are maintained.

All required postings were observed to be posted and accessible for review in the Living Room. The facility last conducted an emergency drill on 8/29/2025. Drills are properly logged and documented.

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.
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NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Jonathan Tse
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2025

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: REYES, MARISELA	FACILITY NUMBER: 414005167
	VISIT DATE: 10/16/2025

NARRATIVE

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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-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.

During the exit interview, Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

See LIC809-D for deficiencies cited today regarding physical plant and infant safe sleep. See LIC9102-TV for technical violations issued today. See LIC9102-TA for technical assistance provided today regarding infant safe sleep. 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, Marisela Reyes.

This report was translated into Spanish by LPA Zaragoza.

NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Jonathan Tse
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/16/2025 02:58 PM - It Cannot Be Edited

Created By: Jonathan Tse On 10/16/2025 at 02:02 PM

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: REYES, MARISELA	FACILITY NUMBER: 414005167
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/16/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above by not securing or rendering inaccessible objects or equipment not suitable for children's use, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/06/2025
	Plan of Correction
1 2 3 4	Licensee shall ensure that the following items are inaccessible to children in care: the door to the Garage, cover to the crawlspace, cooler, power meter, the grill, the broken tarp, the disassembled metal airplane structure, the shed in the Backyard, and above-ground pipes. Licensee shall block off all listed items above inappropriate for use by children, and dispose of the tarp, grill, anddisassembled structure by 11/6/2025.

Type B

Section Cited

CCR

102425(f)

Infant Safe Sleep

An infant shall not be swaddled while in care. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above by having an infant nap in a sleep sack which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/06/2025
	Plan of Correction
1 2 3 4	Licensee removed the sleep sack during the visit. Licensee shall cease use of all sleep sacks and return them to families as necessary by 11/6/2025.

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:

	Jonathan Tse
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2025

LIC809 (FAS) - (06/04)

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