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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414005228
Report Date: 03/06/2026
Date Signed: 03/06/2026 03:06:35 PM

Document Has Been Signed on 03/06/2026 03:06 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:MI SECOND CASAFACILITY NUMBER:
414005228
ADMINISTRATOR/
DIRECTOR:		MICHAEL TEJADAFACILITY TYPE:
860
ADDRESS:847 N. SAN MATEO DRIVETELEPHONE:
(650) 300-1895
CITY:SAN MATEOSTATE: CAZIP CODE:
94401
CAPACITY: 40TOTAL ENROLLED CHILDREN: 13CENSUS: 9DATE:
03/06/2026
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:05 PM
MET WITH:Director, Michael TejadaTIME VISIT/
INSPECTION COMPLETED:
04:25 PM
NARRATIVE
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On March 6, 2025, at approximately 1:05pm, Licensing Program Analysts (LPAs) Tapia-Mandujano and Quimbo conducted an unannounced, Case Management - Lead Testing/Exceedance inspection for Mi Second Casa. LPAs were granted entry by facility staff. At approximately 12:20pm, Director Michael Tejada arrived at the facility. LPAs explained the purpose of the inspection to Director.

The facility is a multi-level facility that includes age components of infants, toddlers, and preschoolers. Present during the inspection are 2 staff supervising a total of 3 infants in the “Conejitos” Classroom and 1 staff supervising 6 toddlers in the “Pajaritos” classroom. There were two other staff that were on lunch break. Per Director, the facility currently does not have any preschool children enrolled and preschool classrooms are non-operating.

LPAs, with Director, conducted a health and safety inspection. During inspection, LPAs observed all staff present have obtained fingerprint clearance and are associated to the facility. Facility is also currently operating within the teacher-to-child ratio.

LPA discussed the new Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018 requires the Lead Testing of water in the Child Care Center with the site director during the inspection. All Child Care Centers that are located in buildings constructed before January 1, 2010, must have their water tested and post the results by January 1, 2023, and every 5 years after the date of the first testing.

For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).

The facility tested four faucets for Lead on December 4, 2025. The facility received the ALE report from the Vendor on December 12, 2025. Three out of the four fixtures tested were within the 5.5 parts per billion (ppb). One fixture exceeded a higher level of ppb allowed. The affected fixture is D that exceeded with 11ppb. D fixture is located in the second level inside the kitchen/staff room. LPAs observed that the second level is currently not being used for childcare. Access to the second level is also made inaccessible with a child safety gate. LPAs also observed that the door to the kitchen/staff room is maintained closed to make inaccessible to children in care.

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NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Leslit Tapia-Mandujano
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2026
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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Document Has Been Signed on 03/06/2026 03:06 PM - It Cannot Be Edited


Created By: Leslit Tapia-Mandujano On 03/06/2026 at 02:28 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: MI SECOND CASA
FACILITY NUMBER: 414005228

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/06/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/06/2026
Section Cited

101700.3(b)(1)

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101700.3 California Lead Action Level at Child Care Centers: (b)(1) "A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance."

This requirement was not met as evidenced by:
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The facility will take the measure to permanently remove the affected fixture.


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Based on observation, interview, and record review, the licensee did not comply with the section cited above as faucet D exceeded 5.5ppb, which poses a potential health, safety or personal rights risk to persons in care.
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Once the fixture has been permanently removed, facility must submit proof to LPA Tapia-Mandujano via email.

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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: 03/06/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/06/2026


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: MI SECOND CASA
FACILITY NUMBER: 414005228
VISIT DATE: 03/06/2026
NARRATIVE
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Page 2 Continued...

The facility was proactive and made the affected fixture inaccessible. Per Director, staff were instructed not to use the affected fixture and were instructed to only use the fixture that passed the lead testing for drinking and/or prepping food. Per Director, initially the facility was going to remove and replace the affected fixture and then retest. Director later decided that instead the facility will permanently remove the fixture. Due to the action taken that will be taken, the facility will not retest that faucet for lead.

During inspection, LPAs obtained the copies of the External Water Sampler Self-Certification Form (LIC9275), Child Care Center Sampling Checklist (LIC9276), Facility Sketch (LIC999).

Deficiencies were cited today under CCR, Title 22, Div. 12, Chapt. 1.

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

Exit interview was conducted and report was reviewed with Director, Michael Tejada.

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

DATE: 03/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2026
LIC809 (FAS) - (06/04)
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