414001226-9-25-2025-05-CC-RWAA-DLUR4Z-20250925124221

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414001226
Report Date: 09/25/2025
Date Signed: 09/25/2025 12:42:38 PM

Document Has Been Signed on 09/25/2025 12:42 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:	CITY OF PACIFICA - SUNSET RIDGE CHILD CARE CENTER		FACILITY NUMBER:	414001226
ADMINISTRATOR/ DIRECTOR:	LISA MENCONI		FACILITY TYPE:	840
ADDRESS:	340 INVERNESS, RMS. 1 & 2		TELEPHONE:	(650) 738-7465
CITY:	PACIFICA	STATE: CA	ZIP CODE:	94044
CAPACITY: 102	TOTAL ENROLLED CHILDREN: 94	CENSUS: 0	DATE:	09/25/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:10 AM
MET WITH:	Eva Tong		TIME VISIT/ INSPECTION COMPLETED:	01:00 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 9/25/2025, at 9:10 AM, Licensing Program Analysts (LPAs) Wadhwa and Leong conducted an unannounced, annual inspection in conjunction with a case management visit for a self-reported incident reported to the department on 8/15/2025. LPAs met with Childcare Assistant Supervisor Eva Tong and Lead Teacher Nicole Hernandez. All adults present today have fingerprints and background clearance on file. The facility operates an after school program for children in the grades of TK -5^th, out of portables P1, P2 and P3 located on Sunset Ridge Elementary School site. Hours of operation are Monday through Friday 7:00am to 6:00 pm. There were no children and only two staff present during today’s visit. LPAs toured the facility with the Assistant Supervisor to conduct a health and safety inspection. LPAs observed the classrooms to include a variety of toys and materials that were in good condition. The classrooms have age-appropriate furniture, equipment, and materials. Storage for children's belongings is inside the classroom. LPAs observed cleaning products to be stored on high shelves in the kitchen areas of Room P2. Classrooms are equipped with multiple fully charged fire extinguisher and multiple first aid kits. LPAs observed multiple Carbon monoxide and smoke detectors in the classrooms. The facility has four bathrooms with 4 toilets and 3 sinks across three portables. LPAs observed all toilets and sinks to be in working condition and equipped with sanitation supplies. Continued on Page 2

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Ruhi Wadhwa
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2025

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 5

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)

Page: 2 of 5

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: CITY OF PACIFICA - SUNSET RIDGE CHILD CARE CENTER	FACILITY NUMBER: 414001226
	VISIT DATE: 09/25/2025

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
26
27
28
29
30
31
32

Page 2
Per Assistant Supervisor , the facility provides an afternoon snack to children in care. LPAs inspected food storage and found food items to be properly covered and not expired.

Outdoor areas are entirely enclosed and fenced. LPAs observed play structures to have cushion flooring. and all play equipment to be in good condition.

Program uses paper sign in and out requiring parents wet signatures.The program had 27 children in care this morning between the hours of 7:00 AM and 8:45 AM. LPAs reviewed sign in/sign out sheet for 9/25/2025 and observed all children to be properly signed in.

LPAs observed licensing posters and required documents to be properly posted. The program’s last disaster drills were conducted on 6/10/2025.

LPAs reviewed children’s facility records which were complete and had all required documents. Children's records have emergency information on file. LPAs reviewed facility staff records and found them to be complete with all the required immunizations and licensing forms. LPAs found two staff to not have a current Mandated Reporter Training Certificate. A technical violation was issued.

LPAs reviewed medication for 3 children and found that one child's Epipen stored at the facility was expired. LPAs advised Assistant Supervisor to ensure the medication was disposed of and the parent was notified to provide a current Epipen. A technical violation was issued.

On this day, LPAs also conducted a case management that was related to an incident that occurred on 8/15/2025. The incident involved a child attempting to reach a monkey bar but missed grasping it, resulting in a fall and a fractured wrist.

LPAs interviewed Assistant Supervisor regarding the incident and found the facility had taken appropriate measures to minimize the injury and ensured child received immediate first aid and medical attention. LPAs concluded the incident was an accident and did not result from lack of supervision. LPAs advised Assistant Supervisor for staff to provide more supervision and guidance for the use of monkey bars.
Continued on Page 3

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Ruhi Wadhwa
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2025

LIC809 (FAS) - (06/04)

Page: 4 of 5

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: CITY OF PACIFICA - SUNSET RIDGE CHILD CARE CENTER	FACILITY NUMBER: 414001226
	VISIT DATE: 09/25/2025

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
26
27
28
29
30
31
32

Page 3
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

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.

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.

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.

LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP

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-care-centers/..

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

Exit interview conducted and report was reviewed with the Facility representative, Eva Tong.

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Ruhi Wadhwa
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2025

LIC809 (FAS) - (06/04)

Page: 5 of 5