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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414005190
Report Date: 03/10/2026
Date Signed: 03/10/2026 12:27:16 PM

Document Has Been Signed on 03/10/2026 12:27 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:MACHADO, GISELLEFACILITY NUMBER:
414005190
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 4CENSUS: 2DATE:
03/10/2026
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:23 AM
MET WITH:Licensee, Giselle MachadoTIME VISIT/
INSPECTION COMPLETED:
12:40 PM
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On March 10, 2026 at 9:00AM, Licensing Program Analyst (LPA) Alvarado arrived at the facility to conduct an unannounced case management for a room addition and increase of capacity. LPA Alvarado met with the licensee Giselle Machado (L1). Purpose of the inspection was explained. (L1) wanted to add Bedroom 2 that was currently off limits and only used as a pass through to the outdoor space for Family Child Care Home use, with the intent of only for napping purposes. With also wanting to add the Dinning Room. Facility is small license and also submitted an application to the department for an increase of capacity and Fire clearance was required prior to department approval. The department receive fire clearance that was granted on 3/5/2026. Present in the facility was (L1) supervising 1 child present (Infant) with then another Infant arriving shortly after. All adults present in the home have fingerprint clearance and are associated with the facility as of today’s inspection.

The facility is a small license and is operating within capacity limits and ratio during today’s inspection. (L1) was reminded that once a large License 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.

LPA along with (L1) inspected day care areas for health and safety hazards. (L1) is adding Bedroom 2. LPA inspected the bedroom, Per (L1) Bedroom 2 will primarily be used for Infants to Nap in to place the pack n plays to open up for more room in the living room. LPA also inspected the Dining Room, that will also be opened up to be part of the Family Child Care Home.

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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.

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: MACHADO, GISELLE
FACILITY NUMBER: 414005190
VISIT DATE: 03/10/2026
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DAY CARE AREAS: Living room (Main Day Care Area), Bathroom, Room #2 (Pass through only to outdoor area), and Only the enclosed outdoor area within the tan picket fence.

OFF LIMIT AREAS: Dining Room, Kitchen, Hallway Closet, Laundry Room, Bedroom #1, the outer part of the enclosed outdoor area, and Garage.

LPA observed that off limit areas were properly barricaded and made inaccessible to the children in care. LPA observed home to be clean and in good repair. There are a variety of age-appropriate toys and equipment in the home which are in good condition, outlets were observed to be made inaccessible.

As of today March 10, 2026 Bedroom 2 has been added and approved as part of the day care area as napping room as well as it will continue to be a pass through for when the facility will go outdoors. Dining Room also has been approved and is now part of the Family Child Care Home.

Newly approved areas of the home will include as follows:

DAY CARE AREAS: Living room (Main Day Care Area), Dining Room, Bathroom, Room #2 (Nap Room and Pass through to outdoor area), and Only the enclosed outdoor area within the tan picket fence.

OFF LIMIT AREAS: Kitchen, Hallway Closet, Laundry Room, Bedroom #1, the outer part of the enclosed outdoor area, and Garage on the ground level.

(L1) was reminded that prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changes. Including 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.

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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: MACHADO, GISELLE
FACILITY NUMBER: 414005190
VISIT DATE: 03/10/2026
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The applicant has not obtained a signed Property Owner/Landlord Consent form (LIC 9149). Without this consent, the applicant understands that, once licensed, they can operate with a maximum capacity of 12 children. If property owner/landlord consent is obtained in the future, the applicant is advised that a new Application for a Family Child Care Home License (LIC 279) must be submitted with a change of capacity fee of $25, to increase the capacity and provide care to 14 children.

No deficiencies were cited today March 10, 2026 during today’s inspection under CCR, Title 22, Div. 12, Chapt. 1.

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

Exit interview was conducted and report was reviewed by licensee, Giselle Machado.
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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