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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414005089
Report Date: 03/27/2025
Date Signed: 03/27/2025 02:56:11 PM

Document Has Been Signed on 03/27/2025 02:56 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:TEJADA DE GUTIERREZ, LILIANFACILITY NUMBER:
414005089
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 7CENSUS: 5DATE:
03/27/2025
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Lilian Tejada de GutierrezTIME VISIT/
INSPECTION COMPLETED:
03:30 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 March 27, 2025 at approximately 2:30pm, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, case management visit to licensee's home. LPA met with licensee, Lilian Tejada de Gutierrez, and explained the purpose of the visit.

Present during LPA's visit included licensee, licensee's spouse and 5 enrolled children (2 infants and 3 preschool age). Licensee is operating within capacity limits and ratio during LPA's visit. Hours of operation are Monday through Friday 7:00am to 11:00pm.

Licensee requested to add off limit areas of home as day care areas. Licensee submitted documentation to department February 10, 2025. LPA inspected areas to be added for health and safety hazards.

Licensee lives in the home with their spouse and minor child. Licensee and licensee's spouse have fingerprint clearance on file. LPA observed licensee has added multiple fire extinguishers throughout the home. There are also multiple smoke and carbon monoxide detectors throughout the home.

Licensee plans for bedroom #1 to be a napping room for infants and/or preschool children. Licensee plans for infants to sleep in a pack and play crib. During today's visit, LPA observed children to also be sleeping on cots. Flooring in bedroom #1 includes soft padding that was clean and free of stains. Licensee plans to store poisons, chemicals and hazardous materials in napping room's high shelves, inaccessible to children.

During today's visit, LPA observed pack and play cribs to be folded and stored appropriately. LPA reminded licensee when cribs are in use, cribs must be free of all loose articles, materials and objects. LPA also reminded licensee door to where infants will be sleeping must remain open at all times.

Hallway will be utilized for children's use as an eating area, separating the play area and sleeping area. LPA observed hallway's electrical outlets to be made inaccessible with child safety covers. Licensee has also installed a child safety gate to kitchen and child safety gate to living room for additional separation.

(Continue Report on Page 2...)
NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/27/2025
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 3
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 3
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: TEJADA DE GUTIERREZ, LILIAN
FACILITY NUMBER: 414005089
VISIT DATE: 03/27/2025
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
(Continued, Page 2...)
Access to outdoor area will be through home's stairs as a pass by area only. Outdoor area includes a patio, upper backyard and lower backyard.

Licensee plans to utilize patio and upper backyard as a day care area only. Lower backyard will remain off limits to children and is made inaccessible with a child safety gate. LPA observed patio and upper backyard to be entirely enclosed and fenced. Outdoor area includes a variety of toys and materials that are in good condition. There are built in rocks in backyard that are fenced and made inaccessible to children. Flooring in backyard includes artificial turf that is in good condition. There is a sandbox in backyard that includes a cover, when not in use. Backyard also includes a gazebo for sufficient shade. LPA did not observe any pools, spas or bodies of water on site.

The DAY CARE AREAS now approved are the living room (main day care area), bedroom #1 (napping room next to living room), hallway, kitchen, bathroom #1 (next to kitchen), patio and upper level backyard. The OFF LIMIT AREAS are bedroom #2, bedroom #3, garage, in-law unit on ground floor, and lower level backyard. Off limit areas are made inaccessible with child safety locks and/or a child safety gate.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/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.

LPA will approve for bedroom #1, hallway, patio, and upper level backyard as day care areas, effective today's date.

No deficiencies were issued today. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Lilian Tejada de Gutierrez.
NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2025
LIC809 (FAS) - (06/04)
Page: 3 of 3