<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414001839
Report Date: 09/03/2025
Date Signed: 09/03/2025 04:33:25 PM

Document Has Been Signed on 09/03/2025 04:33 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:ALVARADO, ZENEYDAFACILITY NUMBER:
414001839
ADMINISTRATOR/
DIRECTOR:		ALVARADO, Z. & ANGULO, R.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 892-9036
CITY:SOUTH SAN FRANCISCOSTATE: CAZIP CODE:
94080
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
09/03/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:38 AM
MET WITH:Zeneyda AlvaradoTIME VISIT/
INSPECTION COMPLETED:
04:50 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 9/3/2025, at approximately 8:45AM Licensing Program Analyst (LPA) Alvarado conducted an unannounced annual visit at the facility. LPA Alvarado met with Licensee Zeneyda Alvarado(L1) and disclosed the purpose of the visit for today. LPA Alvarado observed Present in the Facility is (L1), and assistant supervising 6 children (3 Infants and 3 Preschoolers). The licensee is a large license and is operating within capacity limits and ratio during today’s inspection. Everyone in the household has fingerprint clearance and is associated to the facility during today’s inspection.

Daycare area: Living Room 1, Dining Room, Bedroom 2, Bathroom 1, outdoor Play Space 1.
OFF limit area: Front Yard, Bedroom 1, Kitchen, Living Room 2 (Pass through only to outdoors space, Bedroom 3, Bedroom 4, Bedroom 5, Bathroom 2 and 3, and Outdoor space 2 (Back of the house).

LPA Alvarado reminded the licensee that prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changes. Also, including that any off-limit areas must be approved by the department prior to use. LPA also reminded (L1) that any areas that are not acessible for children must be made inacessible to children such as with baby gates and child locks.

At approximately 9:00AM LPA inspected the home for any health or safety hazards along with (L1). The home is clean and in orderly condition. The home is equipped with a fully charged 2-A:10-B:C fire extinguisher. Facility has a smoke alarm and Carbon monoxide detector that was tested and observed to be functioning during today’s inspection. Facility has a heater that appears as a fireplace and (L1) cover it so children do not have acess. LPA observed the facility to provide care for children in a garage, LPA Alvarado informed (L1) that it is off limits and (L1) removed the children and were brough back indoors to the main house. LPA Alvarado observed blankets and loose articles in the crib and LPA Alvarado discussed safe sleep No infants were present in the crib at the time or observed to be sleeping. (L1) removed it immediately and made it inaccessible.

Continued on Page 2...
NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Diana Alvarado
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/03/2025
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 16
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 16
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: ALVARADO, ZENEYDA
FACILITY NUMBER: 414001839
VISIT DATE: 09/03/2025
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 Continued...

Facility hours of operation are Monday-Friday 7:30AM-5:30PM. LPA observed age-appropriate toys and learning materials to be present. Furniture is age-appropriate and free of rough, loose, or sharp edges. Per (L1) Facility provides Breakfast, Lunch, snack and dinner if needed. (L1) also stated that parents provide the formula or breast milk for infants in care, and was observed to be properly stored in the fridge. (L1) provides napping equipment which was observed such as pack n plays and cots. (L1) stated that families bring blankets from home and facility will wash napping equipment weekly or as needed. Per (L1) there are no firearms present in the facility. All chemicals and Poisons are locked and made inaccessible to children. Facility has partial of a first aid kit and was suggested to have a complete first aid incase of an emaergency. Phone number listed on file for Licensee is current. Facility has two pets in the facility that are located in an off limit are of the home and do not come in contact with the children.

No pools, hot tubs, spas, fishponds or similar bodies of water observed on the property. The license also confirmed no bodies of water on property. License was reminded that Babywalkers, bouncers, jumpers and similar items will not be used for children in care and are not allowed. (L1) and assistants have current Pediatric CPR/First Aid that will expire 10/2025. (L1) and assistant also have current Mandated Reporter Training that Expires 1/2026. (L1) was reminded that CPR/First Aid and Mandated Reporter Training needs to be renewed every two years.

LPA at approximately 11:00AM reviewed 6 children’s Records, Personnel Records (Licensees & Assistant Present). Required postings were observed to be posted in a prominent publicly accessible area of the facility.

(L1) was provided by LPA Alvarado a packet containing the Recently Approved Safe Sleep Regulations in Effect PIN 20-24-CCP , along with a Copy of the Infant Sleep Chart for Documentation of the Infant 15-Minute check, a copy of the Infant Sleeping Plan (LIC 9227), CDSS additional information regarding Safe Sleep in Child Care information and a Copy of the Family Child Care Homes Regulations that include 102352. Definitions, 102417. Operation of a Family Child Care Home, 102425. Infant Safe Sleep, and 102426. Overnight Care.

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.

Continued on Page 3...
NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Diana Alvarado
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2025
LIC809 (FAS) - (06/04)
Page: 3 of 16
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: ALVARADO, ZENEYDA
FACILITY NUMBER: 414001839
VISIT DATE: 09/03/2025
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 Continued...

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.

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.

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/.

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

See LIC 809-D for deficiencies being cited today on 9/3/2025 under the California Code of Regulations, Title 22, Division 12, Chapter 1. Regarding Care and Supervision, Facility Administration, and Records.

See LIC9102-TV for Technical Violation issued today regarding Physical Plant and Records.

See LIC9102-TA for Technical Advisory issued today regarding Physical Plant, Facility Administration, and Records.

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. Appeal rights were provided to Licensee, Zeneyda Alvarado.

Exit interview conducted and report was reviewed with the licensee, Zeneyda Alvarado.
NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Diana Alvarado
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2025
LIC809 (FAS) - (06/04)
Page: 4 of 16
Document Has Been Signed on 09/03/2025 04:33 PM - It Cannot Be Edited


Created By: Diana Alvarado On 09/03/2025 at 02:19 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: ALVARADO, ZENEYDA
FACILITY NUMBER: 414001839

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/03/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview and record review, the licensee did not comply with the section cited above in three out of three infants, licensee has not documented infant 15 Minute sleep Checks which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/19/2025
Plan of Correction
1
2
3
4
Licensee will start documenting infant 15 Minute sleep checks for infant under 24Months, and will submit via email to LPA Alvarado by 9/19/25 LPA Alvarado will also conduct a follow up inspection to ensure that the sleep checks are being documented and maintained for all infants.
Type B
Section Cited
CCR
102416.3(a)(6)
Alterations to Existing Building or Grounds
(a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: (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
1
2
3
4
Based on observation, interview, and record review, the licensee did not comply with the section cited above in the facility was using the Garage for child care and the Garage if off limits based on the last facility sketch that was submitted 7/16/2015 which posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/19/2025
Plan of Correction
1
2
3
4
Licensee will not use the Garage for child care use, Licensee will submit a New LIC 279, LIC 610A, LIC 999A, and Letter of Intent. Licensee will also submit proof of the additional work that was conducted on the home from the construction that occurred after 2015. Facility sketch must reflect the most updated changes to the facility. LPA Alvarado will also conduct a follow-up inspection to ensure that off-limits and Family Child Care Homes are properly labeled and documented.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Ali Zebila
NAME OF LICENSING PROGRAM MANAGER:
Diana Alvarado
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/03/2025


LIC809 (FAS) - (06/04)
Page: 5 of 16
Document Has Been Signed on 09/03/2025 04:33 PM - It Cannot Be Edited


Created By: Diana Alvarado On 09/03/2025 at 02:19 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: ALVARADO, ZENEYDA
FACILITY NUMBER: 414001839

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/03/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview, and record review, the licensee did not comply with the section cited above in one out of one infant, infant in care does not have on file the LIC 9227 which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/05/2025
Plan of Correction
1
2
3
4
Licensee will ensure to have the infant’s parents fill out the LIC 9227 Form and ensure that infants under 12Months must have that form on file for review. LPA Alvarado will also conduct a follow-up inspection to ensure that LIC 9227 is being maintained on file.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Ali Zebila
NAME OF LICENSING PROGRAM MANAGER:
Diana Alvarado
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/03/2025


LIC809 (FAS) - (06/04)
Page: 6 of 16