214005477-11-5-2025-05-CC-NTRN-DN5UDE-20251105142926

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 214005477
Report Date: 11/05/2025
Date Signed: 11/05/2025 02:30:01 PM

Document Has Been Signed on 11/05/2025 02:30 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:	HUMMINGBIRDS COLLABORATIVE SCHOOL		FACILITY NUMBER:	214005477
ADMINISTRATOR/ DIRECTOR:	RICHARD, MELINDA		FACILITY TYPE:	850
ADDRESS:	1990 NOVATO BLVD.		TELEPHONE:	(415) 760-6197
CITY:	NOVATO	STATE: CA	ZIP CODE:	94947
CAPACITY: 42	TOTAL ENROLLED CHILDREN: 42	CENSUS: 29	DATE:	11/05/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	11:15 AM
MET WITH:	Director, Melinda Richard		TIME VISIT/ INSPECTION COMPLETED:	02:50 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 November 5, 2025, at approximately 11:15AM, Licensing Program Analysts (LPAs) Tran and Van conducted an unannounced, annual inspection. LPAs met with teacher, Olimpia Moreno, and explained the purpose of the visit. Licensee, Melinda Richard, later joined the visit. Present during the visit was director, 6 staff, and 29 preschool age children. Hours of operation are Monday to Friday from 7:30AM to 5:00PM. The facility operates in the Lavender Room and Sage Room. The Yurt Tent in the outdoor area is used for storage only. LPAs inspected all classrooms and childcare areas for health and safety hazards with director. LPAs observed electrical outlets in classrooms to be made inaccessible with child safety covers or barricaded by furniture. Facility is equipped with multiple fully charged fire extinguishers, smoke alarm, and a fire alarm system. LPAs tested and verified the functionality of a carbon monoxide detector. Chemicals, poisons, and cleaning solutions have been made inaccessible to children. LPAs observed a variety of age-appropriate toys that are in good condition. Classrooms have fine motor play areas, activity tables, and areas for rest and relaxation. Age-appropriate furniture was observed to be maintained in good condition, free of sharp, loose or pointed parts. LPAs observed cabinets in classrooms to have child safety locks on them. Personal storage cubbies for children's belongings are located inside classrooms. The facility provides morning and afternoon snacks as well as hot lunch. Children also have the option to bring lunch from home. Children bring water bottles from home and can refill them from water dispensers in classrooms. Per director, the facility has a water vendor. Water from the vendor is used to clean food and refill water dispensers. Per director, there are no currently enrolled children with allergies. Continued on Page Two

NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Nicole Tran
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 11/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2025

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: HUMMINGBIRDS COLLABORATIVE SCHOOL	FACILITY NUMBER: 214005477
	VISIT DATE: 11/05/2025

NARRATIVE

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Children nap on mats in classrooms. LPAs observed mats and children’s bedding to be appropriately stored. Per director, the facility provides sheets and launders them weekly. Families provide blankets and brings them home weekly to wash. Mats are wiped down weekly with disinfectant wipes by staff.

Restrooms for children's use were observed to be in working condition. LPAs observed children's restrooms to have age-appropriate toileting equipment and hand washing materials. A changing table is available within arm’s reach of a sink. Per director, parents provide diapers and the facility has extra if needed. Wet wipes are provided by the facility.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. 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).

Based on record review and interview, the facility submitted a lead water attestation letter and is currently under review.

With director, LPAs inspected the outdoor area for health and safety hazards. Outdoor area is fully enclosed and fenced. There are two large play structures with woodchips underneath to cushion falls. LPAs observed activity tables and a playhouse for children’s use. Age-appropriate toys and equipment were observed to be in good condition. Trees and tarps offer ample shade for children to rest under. Children’s water bottles are readily accessible as well. LPAs did not observe any pools, spas or bodies of water on site.

Licensing documents are properly posted by the facility’s front entrance. The facility utilizes paper sign-in/out sheets. LPAs observed children present to be appropriately signed in during today's visit. The most recent emergency drill was conducted on October 24, 2025 and was properly logged.

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NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Nicole Tran
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 11/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2025

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: HUMMINGBIRDS COLLABORATIVE SCHOOL	FACILITY NUMBER: 214005477
	VISIT DATE: 11/05/2025

NARRATIVE

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LPAs reviewed 6 random children's records. Children's files included their emergency information, consent for emergency medical services, and immunization records. 4 out of 6 children’s files did not have their physician’s report available for review. LPAs advised director that all children must have a physician’s report completed. LPAs reviewed 6 staff files and all reviewed staff have current pediatric CPR/First Aid training. 5 out of 6 staff files did not have their measles record available for review. LPAs advised director that all personnel and volunteers’ files must show proof of measles immunization or immunity. 4 out of 6 staff files did not have their health screening available for review. LPAs advised that all personnel must have a health screening completed by a medical professional documented in their file. Technical violations will be issued regarding children and staff records.

Facility representative was reminded that all adults 18 and over, 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 Child Care Center. 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.

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

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NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Nicole Tran
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 11/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2025

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: HUMMINGBIRDS COLLABORATIVE SCHOOL	FACILITY NUMBER: 214005477
	VISIT DATE: 11/05/2025

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes 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 are available at: https://www.ada.gov/resources/child-care-centers/.

Facility representative 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.

No deficiencies were cited during today’s visit, November 5, 2025.

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

Appeal rights were provided and explained.

Exit interview conducted and report was reviewed with facility representative, Melinda Richard.

NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Nicole Tran
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 11/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2025

LIC809 (FAS) - (06/04)

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