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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414005272
Report Date: 08/14/2025
Date Signed: 08/14/2025 05:40:05 PM

Document Has Been Signed on 08/14/2025 05:40 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:PADILLA, TIFFANYFACILITY NUMBER:
414005272
ADMINISTRATOR/
DIRECTOR:		PADILLA, TIFFANYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 315-8936
CITY:BURLINGAMESTATE: CAZIP CODE:
94010
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
08/14/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:36 PM
MET WITH:Tiffany PadillaTIME VISIT/
INSPECTION COMPLETED:
05:45 PM
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On August 14, 2025, at approximately 2:30 PM, Licensing Program Analyst (LPA) Katie Krenn conducted a scheduled pre-licensing visit at the address listed above. LPA met with Applicant, Tiffany Padilla explained the purpose of the visit. Applicant has applied for a large Family Child Care Home License.

Currently, the applicant’s planned operating hours will be from 8:00AM to 4:30PM, Monday to Friday.
All adults living in the home have received fingerprint clearance.
Applicant rents the home and has given landlord notification.
Daycare Areas: Living Room, Dinning Room, Kitchen, Bathroom #1 (Hallway), and a portion of the backyard.
Off-Limits Areas: Laundry Room, Hallway (pass-through only), Bedroom #1, Bedroom #2, Bedroom #3 Bathroom #2, Front Yard, Driveway, and Garage.

Applicant confirmed that there are no swimming pools, spas, or other similar bodies of water present. LPA observed an empty fountain in the backyard. LPA informed Applicant that the fountain needed to be removed, fenced, or filled in. Applicant said that they plan to fill it. LPA requires photo documentation of the filled in fountain prior to licensure.

LPA verified that Applicant’s phone number and email address were current during the visit.

LPA and Applicant inspected the home for any health or safety hazards. At this time Applicant has not fully moved in as the Applicant is currently licensed at a different address. LPA inspected the home and the backyard.
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NAME OF LICENSING PROGRAM MANAGER: Daniel J Oquendo
NAME OF LICENSING PROGRAM ANALYST: Katie Krenn
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/14/2025
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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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: PADILLA, TIFFANY
FACILITY NUMBER: 414005272
VISIT DATE: 08/14/2025
NARRATIVE
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LPA observed that the home was clean and in excellent condition. LPA observed that the bathroom fixtures were operational. LPA observed that the carpet was free of stains and debris. LPA observed that electrical outlets in the daycare areas were covered to prevent children’s access. LPA observed a child lock to prevent children’s access to the laundry room. There were other child locks in the kitchen to prevent children’s access. Applicant plans to bring additional child’s locks over from current daycare and will send photos or video once they are installed.

Applicant discussed their plans to prepare the yard for children in care. LPA expressed areas of concern and discussed suitable options for the Applicant to implement before children are in care. LPA requires photo and/or video documentation or an in person inspection to ensure that all the areas of concern are addressed.

Applicant has an integrated home security system that monitors for smoke, carbon monoxide, and unauthorized entry. LPA observed a test of the detectors and the subsequent call from the monitoring company following up on the alarm being triggered.

Applicant showed the LPA photos of the toys, furniture, and educational materials that are at their currently licensed home. LPA informed Applicant that prior to licensure the applicant must provide evidence that they are living in the home and that the home has suitable furnishings for children.

Applicant will provide meals through a meal program and will post menus.

LPA reviewed Applicant’s records and found that their Mandated Reporter Training (MRT) and Pediatric First Aid/CPR training are current. Applicant used an EMSA approved training program. LPA reminded Applicant that both the MRT and First Aid/CPR need to be renewed every two years and that current copies need to be available for review. Applicant stated that they understood.

LPA discussed with Applicant the requirement to be present in the home ensuring that children are supervised. In the event of a temporary absence, Applicant shall arrange for a substitute adult to provide care and supervision for children. A suitable adult shall have fingerprint clearance, MRT certification, and First Aid/CPR. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day. Applicant stated that they understood.
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NAME OF LICENSING PROGRAM MANAGER: Daniel J Oquendo
NAME OF LICENSING PROGRAM ANALYST: Katie Krenn
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2025
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: PADILLA, TIFFANY
FACILITY NUMBER: 414005272
VISIT DATE: 08/14/2025
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The Applicant has obtained a signed Property Owner/Landlord Notification form (LIC9151). Applicant is requesting a capacity of 12 children. The applicant is advised that if they want to change increase the capacity then a new Application for a Family Child Care Home License (LIC 279) must be submitted with a signed Property Owner/Landlord Consent form (LIC 9149) and a change of capacity fee of $25, to increase the capacity and provide care to 14 children. LPA informed applicant that their own children under the age of ten years old, would be included in the capacity. Applicant stated that they understood.

LPA reviewed the pre-licensing packet with the Applicant going over all the required postings, required forms, and paperwork. Copies of required forms and Entrance Checklist were provided to the applicant. LPA reviewed the ratio and capacity of a small and large family child care home license. Applicant submitted some additional documentation that the LPA had requested in order to complete the file.

Applicant plans to have liability insurance. LPA informed applicant that if they do not get liability insurance, then parents must sign the Affidavit Regarding Liability Insurance (LIC 282). Applicant stated that they understood.

If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov.
For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/‌inspection-process

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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 licensed 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.


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NAME OF LICENSING PROGRAM MANAGER: Daniel J Oquendo
NAME OF LICENSING PROGRAM ANALYST: Katie Krenn
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2025
LIC809 (FAS) - (06/04)
Page: 4 of 6
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: PADILLA, TIFFANY
FACILITY NUMBER: 414005272
VISIT DATE: 08/14/2025
NARRATIVE
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Incidental Medical Services (IMS) policy was discussed. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

LPA discussed the safe sleep regulations with applicant 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 applicant 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.

Applicant was informed of the MyChildCarePlan.org site, 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.

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

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NAME OF LICENSING PROGRAM MANAGER: Daniel J Oquendo
NAME OF LICENSING PROGRAM ANALYST: Katie Krenn
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2025
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: PADILLA, TIFFANY
FACILITY NUMBER: 414005272
VISIT DATE: 08/14/2025
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LPA requires photo and/or video documentation or an in person inspection to ensure that all the areas of concern are addressed. LPA’s areas of concern and Applicant’s plan to address them.
- The empty fountain will be filled.
- The electrical meter will be covered with a container so that is still accessible, but covered.
- The water shut off pipe, will be cover it with foam, which can be removed for access.
- Planters are to be filled so they are flushed with the paved area. Applicant plans to also use foam mats.
- The sprinklers that extend past the area that is planned to be filled. Applicant plans to remove them.
- There is a lattice structure around a locked shed. It needs to be sanded, painted or stained, needs some additional staples to secure it, and some wood rot needs to be address. Applicant plans to barricade the area until the appropriate repairs are made.
- LPA observed that there was an exposed metal handle that turns to open the window. These are removable. There is some exposed metal that the Applicant plans to cover.
- Applicant plans to remove floor to ceiling curtains and the mechanisms to open and close them.
- Applicant plans to put in barricades to cover the fireplace and prevent access to off-limits areas.
- Applicant will cover the four registers in the daycare areas with suitable coverings to prevent children’s access.
- Applicant will put up the required postings such as the Notification of Parent's Rights Poster (PUB 394), the Earthquake Preparedness Check List (LIC9148), and the Emergency Disaster Plan (LIC 610A) were posted at the entrance where children will be dropped off and picked up by their caregivers.
- Applicant will provide a photo of a fully charged fire 3A40BC fire extinguisher.
- Applicant will provide photos that all the accessible children’s cabinets will have child safety locks.

Licensure approval is pending an approved fire inspection.

Applicant was reminded that they must surrender their other license upon closing the other location.

Exit interview conducted and report was reviewed with the applicant, Tiffany Padilla.

Applicant requested that a digital copy of the report be sent to the email address provided.
NAME OF LICENSING PROGRAM MANAGER: Daniel J Oquendo
NAME OF LICENSING PROGRAM ANALYST: Katie Krenn
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2025
LIC809 (FAS) - (06/04)
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