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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410500510
Report Date: 09/30/2025
Date Signed: 09/30/2025 01:45:13 PM

Document Has Been Signed on 09/30/2025 01:45 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:PENINSULA SCHOOL, LTDFACILITY NUMBER:
410500510
ADMINISTRATOR/
DIRECTOR:		TASOVAC, MASAFACILITY TYPE:
850
ADDRESS:920 PENINSULA WAYTELEPHONE:
(650) 325-1584
CITY:MENLO PARKSTATE: CAZIP CODE:
94025
CAPACITY: 40TOTAL ENROLLED CHILDREN: 36CENSUS: 33DATE:
09/30/2025
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:49 AM
MET WITH:Masa TasovacTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
NARRATIVE
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On September 30, 2025 at approximately 11:45AM Licensing Program Analyst (LPA) Katie Krenn arrived at the facility to conduct a continuation of an annual Inspection. LPA met with the Director of Childcare enrichment and preschool, Masa Tasovac and explained that the purpose of today's visit. There were 33 preschool children and eight teachers and aides. The facility remains within its capacity limits and meets the required ratios for today’s visit.

The facility operates Monday through Friday; for the school day the hours are from 9:00AM - 3:00PM
The facility also offers the option of Before Care from 7:30AM - 8:45AM & After Care from 3:00PM - 5:30PM.
Facility is located on campus of Peninsula School, a private Kindergarten - 8th Grade school.
There are no pools, spas, or bodies of water on the property.

The LPA inspected the indoor and outdoor areas for health and safety hazards. The facility was clean, safe, and well-maintained. LPA observed that the outdoor area was free of trash and other debris. The area around and under swings, play structures, and slides is cushion with tanbark. The sand box is inspected every morning before children play in it. The play equipment is in good condition and does not have sharp, loose, or pointed parts.

In the classroom where children are dropped off, LPA observed sign in sheets. LPA also observed that all required documents: such as the facility license, notification of parents’ rights, personal rights, car seat laws, daily activity schedule, evacuation map, and emergency disaster plan, were displayed and visible to the public.

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NAME OF LICENSING PROGRAM MANAGER: Daniel J Oquendo
NAME OF LICENSING PROGRAM ANALYST: Katie Krenn
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/30/2025
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: PENINSULA SCHOOL, LTD
FACILITY NUMBER: 410500510
VISIT DATE: 09/30/2025
NARRATIVE
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The most recent emergency disaster drill was conducted in September, and the LPA observed that it was documented. LPA reviewed the emergency disaster drill log and found that drills are conducted at least once every six months.

The facility had a first aid kit, a smoke detector, a carbon monoxide detector, a charged fire extinguisher, and an emergency disaster kit. The school uses an integrated fire alarm system. LPA tested the carbon monoxide detector and observed that it was functioning.

LPA observed that the two classrooms had age-appropriate toys, furniture, educational materials, and designated cubbies and bins for storage space, which are labeled for each child. LPA did not observed any accessible electrical outlets. The bathrooms were clean, fully operational, and equipped with suitable toileting equipment and sanitation products.

Disinfectants, cleaning solutions, and poisons were securely stored out of children's reach, and all accessible cabinets and drawers in the classrooms were free of hazardous materials.

The preschool program does not currently provide lunch for the children. The families provide lunches for their children. LPA observed that each child had lunch boxes in their designated storage space. According to the director, none of the enrolled children has a documented allergy. The facility provides additional snacks for the children.

The facility offers cots for children to rest or nap. Per the director, the facility provides bedding and launders it onsite. LPA observed a washer and dryer.

LPA observed an empty upside down wading pool. Per the director this is sometimes used on hot days, with immediate supervision and the pool is always emptied after use. LPA did not observe any standing water.



LPA did not reviewed any staff files today. During the previous visit LPA reviewed three staff files and found all the necessary information in the files. LPA did not review any of the children's files during today's visit. During the previous visit, LPA had reviewed the files of five children and found all the required information.

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NAME OF LICENSING PROGRAM MANAGER: Daniel J Oquendo
NAME OF LICENSING PROGRAM ANALYST: Katie Krenn
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2025
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: PENINSULA SCHOOL, LTD
FACILITY NUMBER: 410500510
VISIT DATE: 09/30/2025
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To improve the quality and value of the inspection process, a survey will 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 tools, please send them by email 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.

Director was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

No citations were issued during today's visit.

Exit interview conducted and report was reviewed with the director, Masa Tasovac.
NAME OF LICENSING PROGRAM MANAGER: Daniel J Oquendo
NAME OF LICENSING PROGRAM ANALYST: Katie Krenn
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2025
LIC809 (FAS) - (06/04)
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