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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005623
Report Date: 02/02/2023
Date Signed: 02/02/2023 11:52:53 AM

Document Has Been Signed on 02/02/2023 11:52 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
PENINSULA CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:ACQUA TODDLER HOUSEFACILITY NUMBER:
214005623
ADMINISTRATOR:MENDOZA, NICOLASFACILITY TYPE:
830
ADDRESS:96 PILGRIM WAYTELEPHONE:
(415) 755-7075
CITY:SAN RAFAELSTATE: CAZIP CODE:
94903
CAPACITY: 16TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
02/02/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Nicolas MendozaTIME COMPLETED:
12:00 PM
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On February 2, 2023 at approximately 9:00am, Licensing Program Analyst (LPA) Catrina Quimbo, conducted a pre-licensing inspection. LPA met with applicant, Nicolas Mendoza, and explained the purpose of the inspection.

The applicant is requesting for a combination center of an infant application with a toddler option component. The applicant is requesting an infant capacity of 8 children (birth to 24 months) and a toddler option capacity of 8 children (18 months to 36 months). Department received facility's fire clearance 01/26/2023.

Hours of operation will be Monday to Friday 7:00am to 6:00pm. The facility director will be applicant, Nicolas Mendoza. Applicant plans to have children's authorized representatives' sign children in and out of facility with written signatures. In future, applicant may plan to utilize electronic signatures. LPA measured space indoors and outdoors for preliminary capacity.

Indoors: The facility contains two classrooms: infant classroom and toddler classroom. The infant classroom measures for 330.06 sq. ft. allowing for a capacity of 9 infants. The toddler classroom measures for 506.48 sq. ft. allowing for a capacity of 14 toddlers. The total square footage equals 836.54 sq. ft. allowing for a capacity of 23 children. Applicant is aware infant children and toddler option children must be kept physically separate. Applicant is aware children that participate in toddler option program must have written authorization from children's authorized representatives.

Both the infant and toddler classroom includes two accessible sinks that do not provide water that is warmer than 120 degrees Fahrenheit. Classrooms are equipped with working carbon monoxide detectors, fully charged fire extinguishers and fire alarm system.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE: DATE: 02/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/02/2023
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PENINSULA CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: ACQUA TODDLER HOUSE
FACILITY NUMBER: 214005623
VISIT DATE: 02/02/2023
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Infant classroom also includes a kitchen for staff use only and a napping room. Kitchen in infant classroom is made off limits to children with a child safety gate. Napping room was observed to be equipped with age appropriate cribs.

Facility includes a shared children's restroom that includes 2 children's toilets and 1 adult sink. Applicant plans to have children wash their hands after bathroom use in designated classrooms. The total allowable capacity for toilet ratio is 30 children. The total allowable capacity for sink ratio is 60 children.

Applicant plans to utilize staff lounge also as a nursing area that children's authorized representatives' will have access to.

Outdoors: Facility includes an outdoor space that is located outside of the infant classroom. Outdoor space that will be utilized for program is entirely enclosed with an at least 4 ft. high fence. Outdoor area is shared between residential, neighboring building. Program is to have exclusive use of fenced, outdoor area during hours of operation. Applicant is aware children that are not enrolled in program cannot use outdoor area during program's hours of operation.

There is a neighboring playground area located on the outside of the toddler classroom that includes a play structure with large sandbox. Applicant does not have authorization nor approval from department to utilize play structure with sandbox due to structure not being age appropriate nor fully fenced.

Facility is currently under construction. LPA will return to facility to conduct a follow pre-licensing inspection to inspect physical plant once construction has been fully completed.

Prior to recommended licensure, following must be complete:
-Completion of construction/ classroom set up in facility.
-Posting of licensing documentation.
-Follow up pre-licensing inspection conducted by LPA.

Exit interview conducted and report was reviewed with applicant, Nicolas Mendoza.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023
LIC809 (FAS) - (06/04)
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