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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004554
Report Date: 03/10/2026
Date Signed: 03/10/2026 06:14:35 PM

Document Has Been Signed on 03/10/2026 06:14 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:FERNANDEZ, MORENAFACILITY NUMBER:
414004554
ADMINISTRATOR/
DIRECTOR:		FERNANDEZ, MORENAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 568-1942
CITY:SOUTH SAN FRANCISCOSTATE: CAZIP CODE:
94080
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
03/10/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:34 PM
MET WITH:Licensee, Morena FernandezTIME VISIT/
INSPECTION COMPLETED:
06:30 PM
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On March 10th, 2026, at approximately 1:35PM Licensing Program Analyst (LPA) Alvarado conducted an unannounced annual visit at the facility. LPA Alvarado met with Licensee Fernanda Moreno (L1) and disclosed the purpose of the visit for today. LPA Alvarado observed Present in the Facility is (L1) and assistant supervising (3 Infants, 5 Preschoolers, and 1 School Age Child). Facility is a large license and (L1) 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. Everyone in the household has fingerprint clearance and are associated with the facility as of today’s inspection.

There are three bedrooms, one bathroom, kitchen, dining area, living room, and backyard. All the bedrooms are off limits.

The daycare will operate in the living room, dining room, kitchen (which is child proofed), bathroom, and gated backyard area.

Conversation was had with (L1) regarding the usage of the second floor. LPA along with (L1) 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.

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NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Diana Alvarado
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/10/2026
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.

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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: FERNANDEZ, MORENA
FACILITY NUMBER: 414004554
VISIT DATE: 03/10/2026
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Facility has a smoke alarm and Carbon monoxide detector that were observed to be functioning during today’s inspection. Facility has a fireplace that is located in the living room that was observed to be properly barricaded. Facility also has stairs that were observed to be properly barricaded.

Facility hours of operation are Monday-Friday 8:00AM-4:30PM. LPA observed age-appropriate toys and learning materials to be present. Furniture is age-appropriate and free of rough, loose, or sharp edges. Wall outlets were observed to be inaccessible to children. Per (L1) Facility provides Breakfast, Lunch and Snack. (L1) also stated that parents provide the formula, breast milk and formula for infants. (L1) stated that facility provides napping equipment such as cots, pack n plays, blankets and sheets. (L1) stated that facility washes weekly or as needed and also washed the facility carpet at the end of the week. Per (L1) there are no firearms present in the facility. All chemicals and Poisons are locked and made inaccessible to children.

During the facility walkthrough, LPA observed an Infant with loose items and articles that were present while the infant was present. (L1) removed them immediately making them inaccessible safe sleep was discussed with (L1). LPA also had discussion of the usage of the second floor with (L1) and have asked that a new application to move forward with the process of the second floor.

(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.

No pools, hot tubs, spas, fishponds and or similar bodies of water observed on the property. Licensee 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 assistant has current Pediatric First Aid/CPR that will expire on 1/2028. (L1) and assistant also has the Mandated Reporter Training that Expires 1/2028. (L1) was reminded that Pediatric First Aid/CPR and Mandated Reporter Training need to be renewed every two years and for any assistants as well.

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NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Diana Alvarado
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2026
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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: FERNANDEZ, MORENA
FACILITY NUMBER: 414004554
VISIT DATE: 03/10/2026
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LPA reviewed nine children files for the children who were present during today’s inspection, that were observed to be partially complete. LPA observed that the 15 Min sleep Logs have not been maintained for infants 24Months and under. LPA also reviewed Personnel Records for the (L1) and assistant and reminded (L1) that a personnel record shood be maintained with all required documentation. LPA also was not able to see proof of immunizations for assistant. LPA reviewed Facility documents were observed to be posted and available for review. LPA provided (L1) with the Family Child Care Home Entrance Checklist.

(L1) 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 (L1) 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 [or facility representative] of the importance of checking for and removing any 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/.

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NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Diana Alvarado
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2026
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: FERNANDEZ, MORENA
FACILITY NUMBER: 414004554
VISIT DATE: 03/10/2026
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(L1) 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, the Licensee Morena Fernandez, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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.

See LIC 809-D for deficiencies being cited today on March 10, 2026 under the California Code of Regulations, Title 22, Division 12, Chapter 1. Regarding Physical Plant, Care & Supervision, Facility Administration, and Records.

See LIC9102-TV for Technical Violation issued today regarding Care & Supervision and Records.

See LIC9102-TA for Technical Advisory issued today regarding Records.

A notice of site visit was given and must remain posted for 30 days. Appeal Rights were provided to (L1).

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

DATE: 03/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/10/2026 06:14 PM - It Cannot Be Edited


Created By: Diana Alvarado On 03/10/2026 at 04:40 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: FERNANDEZ, MORENA
FACILITY NUMBER: 414004554

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/10/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(b)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above in two out of three infants, who had loose items inside the crib with infant present which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/20/2026
Plan of Correction
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LPA observed that the licensee removed the items inside the crib and made it inaccessible. LPA reminded the licensee that no items should be present in the infant crib and LPA will conduct a follow up inspection to ensure that cribs are loose items.
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
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Based on observation, interview, and record review, the licensee did not comply with the section cited above in three out of three infants, the licensee has not continued to maintain the 15-Minute Sleep Checks which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/20/2026
Plan of Correction
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Licensee will submit to LPA via email by 3/20/2026 proof of documented 15-Minute sleep Checks. LPA Alvarado will also conduct a follow-up inspection with the facility to ensure that sleep logs are being maintained.
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: 03/10/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/10/2026


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Document Has Been Signed on 03/10/2026 06:14 PM - It Cannot Be Edited


Created By: Diana Alvarado On 03/10/2026 at 04:40 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: FERNANDEZ, MORENA
FACILITY NUMBER: 414004554

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/10/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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
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Based on observation, interview, and record review, the licensee did not comply with the section cited above in updating the department for the usage of the second floor, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/20/2026
Plan of Correction
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Licensee will submit a new application to the department LIC 279, along with an updated facility sketch LIC 999A, Emergency Disaster Plan LIC 610, and a letter of intent regarding wanting to use the second floor. Application will be submitted to the department by 3/20/2026. Second floor will not be in use until the department has approved the usage of the second floor. LPA will conduct a follow-up inspection as well to ensure that areas are documented.
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above in one out of one which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/20/2026
Plan of Correction
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Licensee will submit by 3/20/2026 proof of immunizations of the required immunization for assistant and proof of a completed file for assistant. LPA will conduct a follow-up inspection as well to ensure they have been maintained.
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: 03/10/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/10/2026


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