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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414005199
Report Date: 08/07/2025
Date Signed: 08/07/2025 01:18:14 PM

Document Has Been Signed on 08/07/2025 01:18 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:OLAZABAL, DEYSI MARGARITAFACILITY NUMBER:
414005199
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 6TOTAL ENROLLED CHILDREN: 6CENSUS: 7DATE:
08/07/2025
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:20 AM
MET WITH:Licensee, Deysi Margarita OlazabalTIME VISIT/
INSPECTION COMPLETED:
01:35 PM
NARRATIVE
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On August 7th, 2025 at approximately 10:20am, Licensing Program Analyst (LPA) Tapia-Mandujano conducted an unannounced inspection for an increase of capacity today and met with licensee, Deysi Margarita Olazabal for her request to increase from a Small license to a Large Family Child Care license. Licensee has also requested to add Bedroom #1 and Bedroom #2 to day care area. Fire Clearance was received by Redwood City Fire Department on 07/07/25.

Present in the home are licensee, two assistants, and another adult. Licensee and the two assistants were supervising 7 children (1 infant, 4 preschool age and 2 school age children). Licensee is not operating within capacity limits on this day. All adults living, present, and/or working in the home do not have fingerprint clearance and are associated to the facility. Type A citations were received for both violations.

Licensee rents a one-story level house with three-bedroom, one bathroom home with detached garage. Licensee lives in the home with minor children. The hours of operations will be from Monday-Friday from 8am-5pm. LPA and licensee inspected entire home for Health and Safety Hazards.

LPA inspected Bedroom #1 and Bedroom #2. Bedrooms appeared to be free of any potential hazards. Per license, bedrooms will be used for sleeping only. LPA reminded licensee about maintaining the bedrooms free of any potential hazards and considering the age of children sleeping in the room. LPA also reminded licensee that doors to the bedrooms must maintain open if infant children are sleeping in the room. LPA will approve Bedrooms #2 and #3 for sleeping only.

New Daycare areas are: Living Room, Dining Room, Bedroom #2 and #3, Bathroom #1, Fence portion (left) of backyard. OFF limit areas are: Bedroom #1, Kitchen, Detached Garage, Side yards, Fenced portion (right) of the Backyard, Front Yard, Side Yards, and Driveway. All off-limit areas are properly barricaded, including all closets.

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NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Leslit Tapia-Mandujano
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/07/2025
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 4
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 08/07/2025 01:18 PM - It Cannot Be Edited


Created By: Leslit Tapia-Mandujano On 08/07/2025 at 12:20 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: OLAZABAL, DEYSI MARGARITA
FACILITY NUMBER: 414005199

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/07/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/08/2025
Section Cited
CCR
102416.5(a)

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102416.5: Staffing Ratio and Capacity:
(a) The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time.

This requirement is not met as evidenced by:
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Facility must reduce capacity to the maximum number of children for whom care may be provided at any given time.

LPA went over capacity limitations will licensee.
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Based on observation, interview, and record review, the licensee did not comply with the section cited above as capacity is 6 children, during today's inspection there are 1 infant, 4 preschoolers, and 2 school age children which poses an immediate health, safety or personal rights risk to persons in care.
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Licensee must submit proof of unenrolled child(ren) and a schedule of how many children are attending each day with times to LPA Tapia-Mandujano via email by the end of business day of 8/08/25.
Request Denied
Type A
08/08/2025
Section Cited
CCR102370(d)

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102370: Criminal Record Clearance: (d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:

This requirement is not met as evidenced by:
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Licensee will ensure that all adults present, living and/or working in the facility will have fingerprint clearance and are associated prior to being present in the facility.

Per licensee, she will go get A1 fingerprinted today.
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Based on observation, interview and record review, the licensee did not comply with the section cited above as there is one adult (A1) present, living and/or working in the home that did not have criminal background clearance or associated, which poses an immediate health, safety or personal rights risk to persons in care.
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Licensee must submit proof of completed LIC 9163 to LPA Tapia-Mandujano via email by the end of business day of 8/08/25.

Civil penalties will be assessed.
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:
Leslit Tapia-Mandujano
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/07/2025


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: OLAZABAL, DEYSI MARGARITA
FACILITY NUMBER: 414005199
VISIT DATE: 08/07/2025
NARRATIVE
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Page 2 Continued...

LPA observed fire alarm installation on the living room wall by Postings with evacuation plan. There is a fully charged fire extinguisher, and a working telephone. Backyard is fenced and properly barricaded. Evacuation exits are the main entrance and the Side gate that leads to the side of the house. Per Licensee, there are no weapons or firearms in the home. The home does not have any pools or bodies of water. Licensee's CPR & First Aid expires on 01/2026. Licensee's Mandated Reporter certificate expires on 11/2026. Licensee was reminded of NO walker, exersaucers, jumpers, bouncers and any similar items to be used for children in care and shall be made inaccessible.

LPA also explained to licensee, due to not having Landlord Consent (LIC 9149) on file, Large license will be for a max capacity of 12 children. Capacity limits of a Small and Large Family Child Care Home were explained. Due to licensee being over capacity, Large license cannot be approved during today’s inspection.

Deficiencies were cited today under CCR, Title 22, Div. 12, Chapt. 1. Refer to LIC 809D for more details.

LPA informed licensee Deysi Margarita Olazabal that this report dated 08/07/25 documents a Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

Also, LPA informed the licensee Deysi Margarita Olazabal to provide a copy of this licensing report dated 08/07/25 that documents any Type A citations to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with licensee, Deysi Margarita Olazabal.

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Leslit Tapia-Mandujano
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2025
LIC809 (FAS) - (06/04)
Page: 4 of 4