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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002930
Report Date: 12/09/2025
Date Signed: 12/09/2025 04:04:02 PM

Document Has Been Signed on 12/09/2025 04:04 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:NEWTON @ ENCINALFACILITY NUMBER:
414002930
ADMINISTRATOR/
DIRECTOR:		DOMINIQUE JOHNSONFACILITY TYPE:
840
ADDRESS:195 ENCINAL AVENUETELEPHONE:
(650) 274-9913
CITY:ATHERTONSTATE: CAZIP CODE:
94027
CAPACITY: 200TOTAL ENROLLED CHILDREN: 150CENSUS: 114DATE:
12/09/2025
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:31 PM
MET WITH:Ruby AndradeTIME VISIT/
INSPECTION COMPLETED:
04:20 PM
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On December 9, 2025, at approximately 2:25pm, Licensing Program Analyst (LPA) Maria Olguin-Leon arrived at the facility. LPA met with Program manager Ruby Andrade and Site Supervisor Moises Ramirez. The purpose of the inspection was explained which was for an unannounced Case Management visit for a classroom addition. Present in the facility today was Program manager, Site supervisor and 19 staff supervising 114 school age children. Facility operates an after-school program: days and hours of operation are Monday – Friday, 11:45am – 6:00pm. After school program follows the school year calendar.

The facility is located on the site of Encinal Elementary School and exempt from classroom measurements. Program is licensed to operate in the following classrooms: 1-4, 8, 9, 11, 13A, 17, 18, 19, 20, 24A, 27, 28, 33, Staff lounge, both multi-purpose rooms, library and school stage. Currently the only classrooms being utilized are classrooms: 11, 13A, 17, 33, and Library. The facility has requested to add classroom #10 to their existing license. Fire clearance was received on November 24, 2025.

LPA inspected Rooms #10 for health and safety hazards. LPA observed a fire extinguisher and an integrated sprinkler alarm system in classroom. Carbon monoxide detector will be stored in facility emergency backpacks, along with first aid kits. Facility will ensure that all the cleaning solutions, poisons, and other chemicals that are dangerous to children are stored inaccessible to the children. Classroom has age-appropriate furniture, games and books. Classroom has proper temperature, lighting and ventilation. Flooring is in good condition and free of any hazards

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care

Cont. page 2…
NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Maria Olguin-Leon
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/09/2025
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: NEWTON @ ENCINAL
FACILITY NUMBER: 414002930
VISIT DATE: 12/09/2025
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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.

For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP).

The director 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.

Site Supervisor was reminded that all operating rooms must comply with Title 22 regulations. The Site Supervisor was also reminded to review classrooms and restrooms for health and safety hazards prior to usage of the rooms.

Prior to approval of room addition, facility must submit or have the following complete:

*Install childproof lock or remove cleaners from under sink cabinet. Send photo to LPA, once completed.

No deficiencies were cited today under CCR, Title 22, Div. 12, Chapt. 1.

A copy of this report, and the “Notice of Site Visit” were given to Site Supervisor. A “Notice of Site Visit” must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

An exit interview was conducted, and the report was reviewed with Program Manager, Ruby Andrade and Site Supervisor, Moises Ramirez.

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Maria Olguin-Leon
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2025
LIC809 (FAS) - (06/04)
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