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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414005217
Report Date: 07/17/2025
Date Signed: 07/17/2025 11:36:07 AM

Document Has Been Signed on 07/17/2025 11:36 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:REZENDE, NATHANY CRISFACILITY NUMBER:
414005217
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 6TOTAL ENROLLED CHILDREN: 6CENSUS: 6DATE:
07/17/2025
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:55 AM
MET WITH:Nathany Rezende, Beatriz Silva TIME VISIT/
INSPECTION COMPLETED:
11:50 AM
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On 7/17/2025 at 8:55AM., Licensing Program Analyst (LPA), Luis Gomez met with Assistant, Beatriz Silva. The purpose of today’s inspection was explained and was for an Unannounced, Case Management inspection- Increase of Capacity. Present was the assistant caring for 4 children. Licensee, 5th and 6th child arrived during visit. (2 infant-age, 4 preschool-age) The licensee’s home is a 3 bedroom, 2 bathroom, 1 level house. Per licensee, days and hours of operations are: Monday- Friday, 7:30AM- 5:00PM., The area designated for childcare are: Living room (Playroom #1); Bedroom #1 (Napping Room); Bathroom #1; and Backyard Areas #1, #2. The areas designated as off-limit are Family room (Pass through only); Bathroom #2; Bedroom #2; Bedroom #3; and Garage. LPA inspected home inside and outside for health and safety hazards.

At 9:00AM., the following was observed: Home was clean, neat, with a variety of age-appropriate playthings available for the children. The floor and ground surfaces were clear of obstruction or fall hazards. The childcare’s furniture and accessible materials were in good repair, and free of sharp corners. Facility has tables and chairs, scaled to the proper size. LPA observed infant feeding chairs with wide-base, and removable table component. The available bathroom (bathroom #1) was clean with fixtures in operating condition. LPA observed fold-down, changing table in the playroom. The applicant has installed child safety gates to prevent access to the off-limit areas. Fireplace located in playroom had been barricaded. The detergents, cleaning compounds, and items which can pose a hazard have been made inaccessible. Home had adequate ventilation, lighting throughout the home, and a comfortable temperature for the children.

For scheduled nap services, LPA observed cots and play pens in bedrooms #1. Per licensee, the napping area will extend into playroom for added space. The home has a functioning telephone service, smoke/ carbon monoxide combination detector; and fully charged fire extinguisher (2A:10BC).

LPA inspected the backyard area. Area was enclosed with playthings (structure, and equipment) in good repair. Home does not have pools, fishponds, spas, jacuzzi or any other bodies of water. (REFER TO 809C, FOR CONT.)

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Luis Gomez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/17/2025
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 4
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: REZENDE, NATHANY CRIS
FACILITY NUMBER: 414005217
VISIT DATE: 07/17/2025
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(PAGE 2)
Licensee’s ‘Cardiopulmonary Resuscitation / First Aid certification was current, expiring on: 3/2026.

Licensee’s Proof of completed mandated reporter training (AB1207) was current, expiring on: 2/2026.

The required forms have been posted and include the Facility License; Emergency Disaster Plan (LIC610A); Notice of Parents Rights (PUB394); and Earthquake Preparedness Checklist.

Per licensee, isolation of an ill child is in the playroom (living room).

During inspection, LPA reviewed with licensee capacity requirements, staffing ratio, and regulations for large capacity.

Licensee was informed that the Department must be notified prior to the use of designated off-limits areas. Licensee was reminded any children under 10 years of age will be counted in the capacity. Licensee was reminded that all food containers brought from home must be properly stored and labeled.

Licensee was informed that as of September 1, 2016, a person may not be employed or volunteer at a childcare facility, unless he or she has been immunized for influenza, pertussis and measles or qualifies for an exemption pursuant to Health and Safety Code 1596.7995 and 1597.662.

Licensee was reminded, all adults 18 years and over, living or working in the home, including employee and volunteers must obtain criminal 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 up to $500.00 maximum per day/ per person will be assessed if this regulation is violated. (REFER TO 809C, FOR CONT.)

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Luis Gomez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2025
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: REZENDE, NATHANY CRIS
FACILITY NUMBER: 414005217
VISIT DATE: 07/17/2025
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Incidental Medical Services (IMS) policy was discussed with applicant. For IMS information, please see PIN 20-02-CCP. When an IMS is provided, a plan for 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- 0382 (TTY) and link to publications: Commonly asked questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important communication platform.

To receive important licensed- related information to licensed facilities, visit the CCLD important information website at https://www.cdss.ca.gov/infosource/community-care-licensing/subscribe and select the child care option to receive email communication.

Approved fire clearance inspection report was received by San Bruno Regional Office on 6/4/2025.

Prior to approval of large capacity licensure, the following must completed:

-Adjust outdoor play structures to comply with installation guidance from the manufacturer

Exit interview and report was conducted with Licensee, Nathany Rezende and copy of this report was provided. This report will be kept in the facility file and made available for public review upon request. Desk Duty is available Monday- Friday between 8:00AM – 5:00PM at (650) 266 -8800.

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Luis Gomez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2025
LIC809 (FAS) - (06/04)
Page: 4 of 4