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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004160
Report Date: 06/20/2025
Date Signed: 06/20/2025 05:06:48 PM

Document Has Been Signed on 06/20/2025 05:06 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:ROLDAN, SILVIA E.FACILITY NUMBER:
384004160
ADMINISTRATOR/
DIRECTOR:		ROLDAN, SILVIA E.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 879-2418
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94118
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 10DATE:
06/20/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:08 PM
MET WITH:Silvia RoldanTIME VISIT/
INSPECTION COMPLETED:
05:20 PM
NARRATIVE
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On June 20, 2025, Licensing Program Analyst (LPA) Leong conducted an unannounced annual visit. LPA met with Licensee Silvia Roldan (S1) and explained the purpose of the visit.

S1 and S2 were caring for ten children (two infants and eight pre-k)) during today’s visit. For today's visit, the facility is observed within capacity limits and ratios.

LPA verified with the CDSS Background Check System that S1 and S2 have current criminal record clearances and are in eligible status.

The facility license, Notifications of Parents’ Rights, and Earthquake Preparedness Checklist were displayed on the bulletin board.

The last emergency disaster drill was conducted on April 10, 2025, and documented in the facility log.

LPA observed C2 sleeping in Bedroom #2, which is off-limits to the children. Therefore, the facility will receive a deficiency,

LPA found Bedroom #2 clean, well-ventilated, and all electrical outlets were installed with child safety covers. S1 provided a new facility sketch to the LPA during today’s visit.

LPA will approve the use of Bedroom # 2, effective June 20, 2025.

The new daycare areas consist of a living room, a dining room, bedroom #1, bedroom #2 (added on June 20, 2025), a bathroom, and a backyard.

The off-limits areas consist of the kitchen and the garage. S1 understands that the off-limits area may not be used for childcare during business hours.

See Page 2

NAME OF LICENSING PROGRAM MANAGER: Garfield Leung
NAME OF LICENSING PROGRAM ANALYST: Hanson Leong
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/20/2025
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: ROLDAN, SILVIA E.
FACILITY NUMBER: 384004160
VISIT DATE: 06/20/2025
NARRATIVE
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A health and safety inspection of the indoor and outdoor daycare areas found the home clean and well-ventilated. Hazardous materials were inaccessible to the children. The bathroom was sanitary and fully operational. The facility has a fire extinguisher, a first aid kit, a carbon monoxide detector, and a smoke detector.

The daycare provides age-appropriate toys, furniture, and learning materials. Safety precautions include using safety covers on electrical outlets and installing child locks on kitchen cabinets containing chemicals or detergents.

S1 confirmed there are no firearms or weapons on the premises.

The backyard is surrounded by a fence and free of debris. Outdoor play equipment is available for children to use and is in good condition. LPA did not find any pools, spas, or other bodies of water on the property.

The facility provides lunch and snacks to its children. S1 reported that none of the children require prescribed medications.

The facility provides play yards and mats for children to take naps in. LPA observed that sheets and blankets were available for the children. Infant mattresses are firm and equipped with appropriately sized sheets. All play yards are well-maintained and free of loose items that could pose safety risks. The parents provide blankets for their children, and the facility provides sheets for its children, which are washed weekly by the facility.

A childcare roster was made available for LPA's review.

LPA requested a review of the facility’s childcare insurance, but the S1 stated that she does not have childcare insurance at this time and is searching for an insurance carrier. Without child care insurance, the facility must have a form (LIC 282) in each child's file. However, it was missing from all the children’s files. Therefore, the facility will receive a deficiency.

A review of five children’s files showed that all records were complete. Infant sleep logs for napping infants, which include the time and person checking on the infants, were reviewed and found to be completed.

A review of S1’s and S2 files showed that both of their Pediatric First Aid/CPR and Mandated Reporter Training certificates are still current.

See Page 3

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

DATE: 06/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2025
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: ROLDAN, SILVIA E.
FACILITY NUMBER: 384004160
VISIT DATE: 06/20/2025
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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.

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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

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, Silvia Roldan, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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.

Please refer to LIC 809D for today's deficiencies.

Appeal Rights were given to the licensee.

A Notice of Site Visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Licensee, Silvia Roldan.

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

DATE: 06/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2025
LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 06/20/2025 05:06 PM - It Cannot Be Edited


Created By: Hanson Leong On 06/20/2025 at 04:28 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: ROLDAN, SILVIA E.
FACILITY NUMBER: 384004160

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/20/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(m)(3)
(3) A file of affidavits signed by each parent with a child enrolled in the home. The affidavit shall state that the parent has been informed that the family child care home does not carry liability insurance or a bond according to standards established by the state.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above. The facility does not have child care insurance or has not completed form LIC 282, which poses a potential health, safety or personal rights risk to children in care.
POC Due Date: 06/27/2025
Plan of Correction
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The licensee said she will purchase child care insurance and submit proof to the department by the POC due date.
Type B
Section Cited
CCR
102416.3(a)(6)
(6) Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. Bedroom # 2 was being used without prior approval from the department, which poses a potential health, safety or personal rights risk to children in care.
POC Due Date: 06/24/2025
Plan of Correction
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During today's visit, the licensee provided a new facility sketch, and the LPA completed a health and safety check of Bedroom #2. The deficiency will be cleared during this visit.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Garfield Leung
NAME OF LICENSING PROGRAM MANAGER:
Hanson Leong
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/20/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/20/2025


LIC809 (FAS) - (06/04)
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