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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214002741
Report Date: 10/20/2025
Date Signed: 10/20/2025 09:33:37 AM

Document Has Been Signed on 10/20/2025 09:33 AM - 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:COHEN, REJANYFACILITY NUMBER:
214002741
ADMINISTRATOR/
DIRECTOR:		COHEN, REJANYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 517-3404
CITY:SAN RAFAELSTATE: CAZIP CODE:
94903
CAPACITY: 14TOTAL ENROLLED CHILDREN: 5CENSUS: 4DATE:
10/20/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
07:10 AM
MET WITH:Rejany CohenTIME VISIT/
INSPECTION COMPLETED:
09:45 AM
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 20, 2025, Licensing Program Analysts (LPAs) Leong and Van conducted a scheduled pre-licensing inspection. LPAs met with Applicant Rejany Cohen and explained the purpose of the inspection. At 8:20 am, one child arrived during the inspection. Three additional children arrived during the inspection.

During the inspection, only the applicant was present in the home. According to the information provided in her application, one additional adult and two children will be residing in the home. Background check clearances has been granted for the applicant and one other adult by CDSS.

On September 26, 2025, an application was submitted requesting the relocation of a licensed Family Child Care Home (FCCH). The applicant previously held a FCCH license under License No. 214005377. On October 16, 2025, the facility obtained fire clearance from the Marin County Fire Department. The applicant plans to operate Monday through Friday, 7:30 am to 5:30 pm. The applicant intends to care for children aged 3 months to school age.

LPAs inspected the entire home for health and safety hazards. The facility is a one-level home. The applicant's home features three bedrooms, one bathroom, a living room, a kitchen, laundry room, and back yard.

The daycare areas include bedroom #2, the playroom, bathroom, and backyard. The off-limits areas include bedroom #1, bedroom # 3, laundry room, and kitchen. The Off-limits areas are made inaccessible with child safety door handle locks. The applicant was notified that any off-limits area is not to be used as a daycare area without prior approval from the department.

See Page 2

NAME OF LICENSING PROGRAM MANAGER: Garfield Leung
NAME OF LICENSING PROGRAM ANALYST: Hanson Leong
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/20/2025
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 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: COHEN, REJANY
FACILITY NUMBER: 214002741
VISIT DATE: 10/20/2025
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
LPAs observed the home to be clean, equipped with a variety of age-appropriate toys and materials. Windows in the playroom have window stoppers and reminded the applicant that the windows shall not exceed four inches when the windows are open. The home is equipped with a smoke and carbon monoxide detector, a fully stocked first aid kit, and a 2 A10BC fire extinguisher LPAs observed that electrical outlets in daycare areas either had child safety covers or were blocked by furniture. According to the applicant, there are no weapons or firearms in the home.

LPAs observed that the accessible drawers did not contain any hazards or poisonous materials. Cleaning solutions, poisons, or hazardous materials were observed to be stored in off-limits locations.

LPAs observed that there were two Pack N Play Pens and three sleep mats in the home, ready to be used. LPAs reminded the applicant that mats and Pack N Play Pens shall be sanitized after each use.

LPAs observed the backyard to be clean and free of hazards. The applicant plans to purchase additional children’s equipment for the backyard and will use it as free play for now. Stairs located in the backyard were observed with anti-slip mats. No pools, spas, or other bodies of water were observed on the premises.

The applicant plans to use a designated cell phone and is aware that it must remain within the home during daycare hours. The applicant was reminded that baby walkers, bouncers, jumpers, and similar items are not to be used with children in care.

The Applicant plans to isolate sick children into other daycare areas depending on where children are located at.

The applicant plans to provide a food service that will include breakfast, lunch, and an afternoon snack. Food storage, preparation, and sanitization were discussed.

The applicant’s Pediatric CPR and First Aid EMSA certification is valid through July 2027, and Mandated Reporter training is current until January 30, 2026. The applicant was reminded that both trainings must be renewed every two years to remain compliant.

The applicant intends to purchase child care insurance. For now, the applicant plans to use form LIC 282 to inform the parents that the facility does not carry child care insurance.

See Page 3

NAME OF LICENSING PROGRAM MANAGER: Garfield Leung
NAME OF LICENSING PROGRAM ANALYST: Hanson Leong
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2025
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: COHEN, REJANY
FACILITY NUMBER: 214002741
VISIT DATE: 10/20/2025
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
The applicant provided proof of control of property.

Because the applicant rents/leases the home, proof of landlord notification is required.. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).

If the applicant provides care for a 13th and 14th child of school age, the applicant must use form LIC 9150 to notify the parents or guardians of all enrolled children. The Emergency Disaster Plan (LIC 610), Parent Rights (LIC 995A), and License (once received) must be posted in an accessible location where parents can see them. LPA reminded the applicant that at least one child is enrolled in and attending kindergarten or elementary school or transitional kindergarten and a second child is at least six years of age.

LPA reminded the applicant that once she is licensed, she must be present at home and ensure that the children in her care are consistently supervised. Additionally, temporary absences should not exceed 20 percent of the daily care hours provided by the facility.

LPA reminded the applicant that once she is licensed, any duly authorized officer, employee, or agent of the Department shall, upon presentation of proper identification, enter and inspect any place providing personal care, supervision, and services at any time, with or without advance notice, to secure compliance with, or to prevent a violation of, the regulations adopted by the Department governing family child care homes

LPA informed the applicant that starting September 1, 2016, no one may be employed or volunteer at a family day care home without having been vaccinated against influenza, pertussis, and measles. LPA reminded the applicant that an individual who works in a family daycare home may submit a written declaration stating that they have declined the influenza vaccination. This exemption applies only to the influenza vaccine.

LPA discussed with the applicant that the capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time.

See Page 4

NAME OF LICENSING PROGRAM MANAGER: Garfield Leung
NAME OF LICENSING PROGRAM ANALYST: Hanson Leong
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2025
LIC809 (FAS) - (06/04)
Page: 4 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: COHEN, REJANY
FACILITY NUMBER: 214002741
VISIT DATE: 10/20/2025
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
Applicant 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.

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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

LPA reviewed with applicant the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance checklist was provided to the applicant.

LPA discussed the safe sleep regulations with applicant 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 applicant 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.

On this date, 09/29/2025, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility address. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Applicant was informed of the MyChildCarePlan.org site, 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.

See Page 5

NAME OF LICENSING PROGRAM MANAGER: Garfield Leung
NAME OF LICENSING PROGRAM ANALYST: Hanson Leong
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2025
LIC809 (FAS) - (06/04)
Page: 5 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: COHEN, REJANY
FACILITY NUMBER: 214002741
VISIT DATE: 10/20/2025
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
***Amended Document***

Page 5

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website athttps://www.cdss.ca.gov/inforesources/community-carelicensing/ subscribe and select the Child Care option to receive email communication.

The applicant provided a list of individuals from the Guardian’s Background Check System and informed the LPAs that she wished to update her facility roster.

The following requirement must be satisfied to proceed with licensure recommendation.

- Management Approval.

Exit interview conducted and report was reviewed with the Applicant, Rejany Cohen.

NAME OF LICENSING PROGRAM MANAGER: Garfield Leung
NAME OF LICENSING PROGRAM ANALYST: Hanson Leong
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2025
LIC809 (FAS) - (06/04)
Page: 6 of 6