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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002105
Report Date: 12/12/2025
Date Signed: 12/12/2025 04:23:45 PM

Document Has Been Signed on 12/12/2025 04:23 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:CHAVEZ DE CERDA, ESTELA M.FACILITY NUMBER:
414002105
ADMINISTRATOR/
DIRECTOR:		CHAVEZ DE CERDA, ESTELA M.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 763-6092
CITY:SOUTH SAN FRANCISCOSTATE: CAZIP CODE:
94080
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 12DATE:
12/12/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:21 PM
MET WITH:Facility Assistant, Yaoaska ChavezTIME VISIT/
INSPECTION COMPLETED:
04:35 PM
NARRATIVE
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On December 12th, 2025, at 1:30PM, Licensing Program Analyst (LPA) Alvarado arrived at the facility to conduct an unannounced Plan of Correction. LPA Alvarado met with the licensee’s daughter and assistant Yaoaska Chavez (S1). Licensee is not present in the facility. During LPAs arrival one child was being picked up by a parent. Per (S1) licensee is not available at the moment. (S1) was reminded that if no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in 102416.5 Staffing Ratio and Capacity. All adults present in the home have fingerprint clearance and are associated to the facility as of today’s inspection. Present in the facility is (S1), and assistant supervising 12 children (3 infants, 6 preschoolers, and 3 school age).

During the Annual inspection on 7/22/2025 LPA cited three Type B deficiency regarding infant safe sleep, immunization's and children records.

During today’s visit, LPA conducted record review for staff reviewing 3 staff files. LPA was able to confirm that staff immunization's are up to date and available for review. LPA also was able to see that staff have current updated Pediatric First Aid/ CPR expiring 7/2027.LPA also conducted 5 children record reviews. LPA observed that children files are up to date and completed and advised on a few forms that were missing. LPA also was able to see that that the 15-Min Sleep checks have been documented and maintained for infants 24 months and under in a notebook. LPA suggested that the facility have a notebook for each infant containing the documented 15-Min sleep checks.

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NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Diana Alvarado
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/12/2025
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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Document Has Been Signed on 12/12/2025 04:23 PM - It Cannot Be Edited


Created By: Diana Alvarado On 12/12/2025 at 03:13 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: CHAVEZ DE CERDA, ESTELA M.
FACILITY NUMBER: 414002105

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/12/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/12/2025
Section Cited
CCR
102425(b)

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102325(b)Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidenced by:
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Facility assistants removed all the items immediately, making the cribs free of loose articles and objects. Facility will be cited and cleared as of 12/12/25.
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Based on observation the facility did not comply with this section as, three infants were observed inside the cribs with items such as a bottle, toy, and bottle which poses a potential health, safety or personal rights risk to persons in care.
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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: 12/12/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/12/2025


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: CHAVEZ DE CERDA, ESTELA M.
FACILITY NUMBER: 414002105
VISIT DATE: 12/12/2025
NARRATIVE
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LPA Alvarado and (S1) conducted a Health and Safety Walk through of the facility indoors and outdoors. During the walkthrough LPA observed three infants in a crib that had loose items such as a bottle and blanket. LPA reminded (S1) that infant cribs must be free of all loose items and articles. (L1) and assistant removed all the loose items and articles immediately. Safe sleep was discussed with (L1).

During the walkthrough of the outdoor yard, (S1) stated that the children have not been using the outdoors space due to the cold weather and therefore a few items have been placed. LPA observed loose debris and was able to confirm that the outdoor space has not been utilized. LPA advised that the outdoor space be cleaned up and have a sweep through for any loose items prior to stepping out and playing and (S1) stated that they already had some trash removers coming this upcoming weekend.

During today’s inspection LPA was able to clear three out of the three Deficiencies that were issued on 7/22/2025. Letters of deficiencies cleared were printed and provided to (S1).

See LIC 809-D for deficiencies being cited today also on 12/12/2025 under the California Code of Regulations, Title 22, Division 12, Chapter 1. Regarding Physical Plant, Care & Supervision, and Records. Deficiencies being cited today regarding Infant Safe sleep.

See LIC9102-TA for Technical Assistance in regard to Operations of a Family Child Care Home and Childs Records.

Appeal Rights were provided to (S1). A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with facility assistant, Yaoaska Chavez.
NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Diana Alvarado
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2025
LIC809 (FAS) - (06/04)
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