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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414005042
Report Date: 09/05/2025
Date Signed: 09/05/2025 11:58:29 AM

Document Has Been Signed on 09/05/2025 11:58 AM - 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:SOARES, ANDREA B.FACILITY NUMBER:
414005042
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
09/05/2025
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:25 AM
MET WITH:Andrea SoaresTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
NARRATIVE
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On 9/5/2025, at approximately 9:25 AM, Licensing Program Analysts (LPAs) Wadhwa and Zaragoza conducted an unannounced, case management visit. LPAs met with the licensee Andrea Soares and explained the purpose of the visit. Present during LPA's visit included the licensee, licensee's daughter, 1 staff assistant, and 5 children (4 infants and 1 preschooler).

At 9:45 AM, based on observations and record review, LPAs confirmed 4 infants, and 1 preschool age child to be present during today’s visit. LPAs observed the facility is operating over capacity. Licensee was advised as a small license capacity, there can be no other children present while having 4 infants in care.

The purpose of today’s visit is for an increase of capacity. Licensee requested to increase capacity from a small family child care home to a large family child care home. Capacity increase application was submitted to department 4/17/2025. Fire clearance approval was obtained on 7/8/2025.

Licensee lives in the home with adult daughter. All adults living and/or working in the home have fingerprint clearance on file. Hours of operation are Monday through Friday 8:00am to 5:30pm.

The DAY CARE AREAS now approved are the Living Room “Play Room 1”, Master bedroom #1, Bedroom #2, Bedroom #3, Bathroom, Side yard and Back yard. The OFF LIMIT AREAS are the Kitchen and the Garage area.
Off limit areas inside the home are made inaccessible with child safety gates. Off limit areas outdoors are made inaccessible to children with locked doors. Home is equipped with a fully charged fire extinguisher, first aid kit and smoke and carbon monoxide detectors.
Continued on Page 2
NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Ruhi Wadhwa
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/05/2025
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 09/05/2025 11:58 AM - It Cannot Be Edited


Created By: Ruhi Wadhwa On 09/05/2025 at 09:48 AM
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: SOARES, ANDREA B.
FACILITY NUMBER: 414005042

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/05/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/05/2025
Section Cited
CCR
102416.5(a)

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102416.5(a) Staffing Ratio and Capacity. The capacity specified on the license shall be the maximum number of children for whom care can be provided..This requirement is not met as evidenced by:
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Licensee will provide a written statement that she understands the capacity requirements and provide a plan with the new schdeule for all enrolled children by POC due date 9/6/2025. The plan must include the time, and days of the week that the children will be present at the facility.
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Based on observations and record review, LPAs confirmed 4 infants and 1 preschooler to be present during today’s visit which poses an immediate 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.
Marie Rodriguez
NAME OF LICENSING PROGRAM MANAGER:
Ruhi Wadhwa
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/05/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/05/2025


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: SOARES, ANDREA B.
FACILITY NUMBER: 414005042
VISIT DATE: 09/05/2025
NARRATIVE
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Capacity limits and ratios for a large family day care have been reviewed with the licensee on this date. LPAs reminded licensee that an assistant must be present when operating as a large license. LPAs reminded licensee when an assistant is not present, licensee must operate within capacity limits of a small family child care home.

Per Fire Department, a fire inspection will be conducted in 6 months from today’s date, 9/5/2025, to ensure building department requirements have been met. Fire clearance may be revoked if not completed.

A type A deficiency was issued during today's visit for overcapacity that was confirmed at 9:45 AM. LPAs informed licensee, Andrea Soares that this report dated 9/5/2025 documenting Type A citation(s) shall be posted for 30 consecutive days as there is immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPAs informed the licensee, Andrea Soares to provide a copy of this licensing report (9/5/2025) that documents any Type A citation (s)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 (LIC9224), or other written statement, must be placed in the child’s file for verification.

1 Type A deficiency was issued during today’s visit, 9/5/2025.

LPAs discussed Plan of Correction with Licensee. Licensee has submitted the discussed Plan of Correction during the visit and was approved for a large family childcare license. Hence, the deficiency has been cleared on the same day and Licensee was provided a copy of a Clear of Deficiency Letter.

LPAs will approve a large license for a capacity of 14 children, as of today’s date, 9/5/2025.

A copy of this report with the appeal rights was provided, and signature of this form acknowledges the receipt of these documents.

Exit interview conducted and report was reviewed with Licensee, Andrea Soares.

Licensee was advised Notice of Site Visit to remain posted for 30 days.
NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Ruhi Wadhwa
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2025
LIC809 (FAS) - (06/04)
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