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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004584
Report Date: 11/06/2025
Date Signed: 11/06/2025 04:31:29 PM

Document Has Been Signed on 11/06/2025 04:31 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:CARDENAS, EDELMIRAFACILITY NUMBER:
414004584
ADMINISTRATOR/
DIRECTOR:		CARDENAS, EDELMIRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 305-9477
CITY:ATHERTONSTATE: CAZIP CODE:
94027
CAPACITY: 14TOTAL ENROLLED CHILDREN: 13CENSUS: 7DATE:
11/06/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Licensee, Edelmira CardenasTIME VISIT/
INSPECTION COMPLETED:
04:35 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 November 6th, 2025, at approximately 10:30am, Licensing Program Analysts (LPAs) Tapia-Mandujano and Olguin-Leon conducted an unannounced random annual inspection and met with licensee, Edelmira Cardenas. LPAs explained the purpose of the inspection to licensee. Present in the facility are licensee and assistant supervising 7 children (4 infants and 3 preschoolers). During today's inspection, all adults living and/or working in the facility are fingerprint cleared and associated. LPA verified Guardian list.

Licensee rents home and lives with her two Adult sons. Home is a 3-bedroom, 2-bathroom, single level house. The hours of operation are Monday-Friday from 8am-5:30pm Daycare areas are: Living room, Playroom, Bathroom #2, and Side yard. OFF limit area: Dining Area/Kitchen, Laundry Room, Bedroom #1, Bathroom #1, Master Bedroom #2, Bedroom #3, Garage, Back yard, and front/side yard. All off limit areas, including all closets, are properly barricaded.

LPAs observed the Day-care is clean, orderly with a variety of age-appropriate toys for the children. The home has age-appropriate equipment available for children in care. During inspection, LPAs observed there are pack and plays/play yards that were soiled and a toy that was broken in outdoor play area (Type B citation was received). Licensee was reminded that baby walkers, bouncers, jumpers, and any other similar items are not to be used for children in care.

LPAs observed that children sleep in the living room and play room. Older children were observed to sleep in a mat and younger children slept in a crib. LPAs observed the cribs to have a tight fitted sheet. LPAs observed assistant remove bottles from cribs of two children who were already inside the crib, and in which one child was already sleeping (Type A citation was received). LPAs observed, licensee is maintaining the safe sleep logs of enrolled infant children.

Continued on Page 2...

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Leslit Tapia-Mandujano
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/06/2025
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 7
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 7
Document Has Been Signed on 11/06/2025 04:31 PM - It Cannot Be Edited


Created By: Leslit Tapia-Mandujano On 11/06/2025 at 02:54 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: CARDENAS, EDELMIRA
FACILITY NUMBER: 414004584

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/06/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
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
1
2
3
4
Based on observation, the licensee did not comply with the section cited above as LPAs observed assistant remove bottles of two children who were already inside the crib, and in which one child was already sleeping. This poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 11/06/2025
Plan of Correction
1
2
3
4
LPAs printed Safe sleep regulations for licensee and explained regulation of cribs/play yards to be free of any loose articles.

Licensee must review regulations and submit a written letter ackowledging that she has reviewed the regulations andher plan to ensure that children are not inside the crib with their bottles.

Civil penalties were assessed due to it being a repeat violation.
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.
Marie Rodriguez
NAME OF LICENSING PROGRAM MANAGER:
Leslit Tapia-Mandujano
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 11/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/06/2025


LIC809 (FAS) - (06/04)
Page: 3 of 7
Document Has Been Signed on 11/06/2025 04:31 PM - It Cannot Be Edited


Created By: Leslit Tapia-Mandujano On 11/06/2025 at 02:54 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: CARDENAS, EDELMIRA
FACILITY NUMBER: 414004584

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/06/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(d)
Operation of A Family Child Care Home
(d) The home shall provide safe toys, play equipment and materials.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above as LPAs observed there are pack and plays/play yard that were soiled and a toy that was broken in outdoor play area, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/07/2025
Plan of Correction
1
2
3
4
LPA will either clean, replace, and/or make equipment that are soiled and/or broken inaccesible to children in care.

Licensee will submit proof that these equipments and toy have been cleaned, replaced, and//or inacessible to children in care.
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.
Marie Rodriguez
NAME OF LICENSING PROGRAM MANAGER:
Leslit Tapia-Mandujano
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 11/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/06/2025


LIC809 (FAS) - (06/04)
Page: 4 of 7
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: CARDENAS, EDELMIRA
FACILITY NUMBER: 414004584
VISIT DATE: 11/06/2025
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...

The home has a fireplace that is not properly secured. Fireplace had a frame that was being held by children mats. LPAs advise licensee to find a way to secure fireplace for it to be barricaded appropriately (Technical Violation was issued). The Home does not have any pools or bodies of water. LPA reminded licensee about water safety. Per licensee, there are no pets in the home. Per licensee, isolation area for sick children is the day care area that is not being used during that time by day care children. Per licensee, discipline policy is redirection.

There was a fully charged fire extinguisher and a smoke and carbon monoxide alarm, and a working telephone. Phone number listed for Licensee is current. Per Licensee, there are no weapons or firearms in the home. LPAs reviewed seven children’s records that were complete. LPAs also reviewed assistants’ file and facility files. Licensee's Mandated reporter training expires on 07/2026. Licensee’s Pediatric CPR/First Aid Certification expires 07/2027. Last Emergency drill was conducted 11/2025. Emergency drills must be conducted at least once every six months and must be properly logged.

LPAs observed that all the required posting documentation, such as the facility license, Notification of Parent Rights, and Notice of Site Visit were posted in a prominent area for parents or representatives to review.

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 atwww.cdss.ca.gov/inforesources/community-care-licensing/inspection-process

Licensee 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 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-and-resources/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.

Continued on Page 3...

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Leslit Tapia-Mandujano
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025
LIC809 (FAS) - (06/04)
Page: 6 of 7
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: CARDENAS, EDELMIRA
FACILITY NUMBER: 414004584
VISIT DATE: 11/06/2025
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...

Incidental Medical Services (IMS) policy was discussed. Licensee does not offer IMS at this moment. 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, the licensee, Edelmira Cardenas, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS on 11/06/25.

Deficiencies were cited today under CCR, Title 22, Div. 12, Chapt. 1.

LPAs Tapia-Mandujano and Olguin-Leon informed licensee, Edelmira Cardenas, that this report dated November 6, 2025, documents one Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

Also, LPAs Tapia-Mandujano and Maria Olguin-Leon informed licensee, Edelmira Cardenas, to provide a copy of this licensing report dated November 6, 2025 that documents any Type A citation to parents/guardians of all children currently enrolled, by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

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

Exit interview was conducted and report was reviewed with Licensee, Edelmira Cardenas, and copy of this report was provided. Appeals right were provided.

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Leslit Tapia-Mandujano
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025
LIC809 (FAS) - (06/04)
Page: 7 of 7