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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005289
Report Date: 08/12/2025
Date Signed: 08/12/2025 12:35:50 PM

Document Has Been Signed on 08/12/2025 12:35 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:BLUNCK-RIBEIRO, ISABELLAFACILITY NUMBER:
214005289
ADMINISTRATOR/
DIRECTOR:		BLUNCK-RIBEIRO, ISABELLAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 250-9278
CITY:SAN RAFAELSTATE: CAZIP CODE:
94901
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
08/12/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Isabella Blunck-RibeiroTIME VISIT/
INSPECTION COMPLETED:
12:50 PM
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On 8/12/2025, Licensing Program Analyst (LPA) Naves conducted an unannounced annual visit to the Family Childcare Home (FCCH) listed above. LPA met with the Licensee, Isabella Blunck Ribeiro, and explained the purpose of the visit. 8 children (1 infant and 6 pre-k) and 3 adults (licensee, licensee's husband, licensee's assistant ) were present during the visit. Licensee's 3 children (all under the age of 18) were also present in the home. The licensee and her husband both at the FCCH have received criminal record clearance from the department. However, licensee did not request a transfer of criminal record clearance for other staff member. Staff member did have record clearance from another licensed child care facility. The FCCH is within its capacity and in accordance with the required ratio of staff to children.

The licensee rents the home and lives with her husband and three children (all under the age of 18). The hours of operation are Monday through Friday from 7:30 a.m. to 5:30 p.m. Three dogs and two cats were present in the home. According to the licensee, the five pets are fully vaccinated.
Licensee offers other languages for children to learn such as Portugese, Spanish, English and sign language

Daycare Areas: Living Room #1, Living Room #2, Bathroom # 1, Playroom, and Lower-Yard Area.
Off-limits areas: Kitchen, Room #1, Room #3, Entire Upstairs, and Deck Area (pass-through only).
cont pg 2 >>>>
NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Jaclyn Naves
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/12/2025
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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Document Has Been Signed on 08/12/2025 12:35 PM - It Cannot Be Edited


Created By: Jaclyn Naves On 08/12/2025 at 12:06 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: BLUNCK-RIBEIRO, ISABELLA
FACILITY NUMBER: 214005289

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/12/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.871(c)(1)(A)
Administration of Child Day Care Licensing
Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision(f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation interview record review the licensee did not comply with the section cited above licensee has unfingerprinted adult caring for children. Upon additional review it was discovered new staff member does have record clearance however it is with another FCCH. Upon further review it was learned that staff members name was not entered correctly in Guardian, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/29/2025
Plan of Correction
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Licensee will get staff member re-fingerprinted with correct complete staff member name and submit proof to LPA by 8/14/25 LPA will associate new staff member upon fingerprint clearance to her facility due to issue with staff information being entered incorrectly.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
Ali Zebila
NAME OF LICENSING PROGRAM MANAGER:
Jaclyn Naves
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/12/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/12/2025


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: BLUNCK-RIBEIRO, ISABELLA
FACILITY NUMBER: 214005289
VISIT DATE: 08/12/2025
NARRATIVE
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LPA observed that all required documents, such as the facility license, the Notification of Parental Rights, and the Earthquake Preparedness Checklist, were displayed in a prominent, publicly accessible location.
According to the licensee, the most recent emergency disaster drill took place on 8/4/2025, and the LPA observed that it was properly documented. LPA reviewed the emergency disaster drill log and found that they were conducted every month.

LPA conducted an inspection for potential health and safety hazards and found the home's interior to be clean and orderly, with proper heating and ventilation for safety and comfort. According to the licensee, she provides food and snacks for the children. LPA reminded the licensee about the importance of sanitation and proper food preparation. The FCCH was observed to have a first aid kit, smoke and carbon monoxide detectors, which were tested and found to be fully functioning and a fully charged fire extinguisher.
LPA observed that the indoor daycare areas were equipped with age-appropriate toys, furniture, and educational materials. No equipment, such as walkers, bouncers, or similar objects, was present in the FCCH. The fireplaces were observed to be properly barricaded. The FCCH was observed with individual permanent or portable storage space for the children’s clothing and personal belongings. Electrical outlets were observed to be properly covered with child safety covers. Feeding chairs were observed to be clean and in good condition.

According to the licensee, no firearms or weapons are on the premises. Poisons, detergents, cleaning compounds, and other potentially hazardous items were stored in the laundry room, which was locked, making them inaccessible to the children.

The outdoor playground was enclosed by a fence, and the play equipment was well-maintained. The areas around and under high climbing equipment, swings, slides, and similar equipment were cushioned with material that absorbs falls. Licensee has artificial turf covering the entire back yard and has a covering to provide shading. No bodies of water, such as pools or spas, were present on site.
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NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Jaclyn Naves
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2025
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: BLUNCK-RIBEIRO, ISABELLA
FACILITY NUMBER: 214005289
VISIT DATE: 08/12/2025
NARRATIVE
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The bathroom was found to be clean and fully operational. The toilet and handwashing facility were well-kept, safe, and clean. The diaper-changing station was found to be clean. Potty chairs were observed to be available for the children.

The sleeping/resting area was observed to be clean and sanitary. Cots, cribs, and sheets were available for children to use. LPA also observed that the infant mattresses were firm and appropriately covered with a fitted sheet appropriate to the child’s size.

LPA reviewed five children’s files and confirmed that all five children have complete files that include their emergency contact and medical information and sleep logs for children under two years old.
LPA reviewed the staff files and confirmed that all required forms were present. LPA found that the licensee possesses a current Pediatric First Aid/CPR certification expiring on 3/2027. Licensee and staff member both have current Mandated Reporter Certifications and licensees expires 4/23/2027.
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.
This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. 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 are available at: https://www.ada.gov/resources/child-carecenters/.
cont pg 4 >>>>
NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Jaclyn Naves
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2025
LIC809 (FAS) - (06/04)
Page: 6 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: BLUNCK-RIBEIRO, ISABELLA
FACILITY NUMBER: 214005289
VISIT DATE: 08/12/2025
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.
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, the licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

On this date, 8/4/2025, 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 addresses. 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.
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.
See 809D for deficiency cited today.
A copy of today's report was given to the Licensee, Isabella Blunck Ribeiro. A Notice of Site Visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee, Isabella Blunck Ribeiro.
NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Jaclyn Naves
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2025
LIC809 (FAS) - (06/04)
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