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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414005288
Report Date: 05/15/2026
Date Signed: 05/15/2026 12:06:18 PM

Document Has Been Signed on 05/15/2026 12:06 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:IHSD, INC.-SAN BRUNOFACILITY NUMBER:
414005288
ADMINISTRATOR/
DIRECTOR:		TBDFACILITY TYPE:
860
ADDRESS:370 SAN BRUNO AVENUE WESTTELEPHONE:
(650) 578-3440
CITY:SAN BRUNOSTATE: CAZIP CODE:
94066
CAPACITY: 9TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
05/15/2026
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Jennifer PifeletiTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
NARRATIVE
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On May 15, 2026 at approximately 9:00am, Licensing Program Analysts (LPAs) Quimbo and Garcia, conducted a scheduled, pre-licensing visit. LPAs met with applicant representative, Jennifer Pifelelti, and explained the purpose of the visit. No children were present during LPAs' visit.

This is an initial application. Application was submitted August 25, 2025. Applicant, Angelita Barrios, is requesting for 9 infants (12 months to 24 months). Fire clearance for 9 infant children was received May 13, 2026. The designated site supervisor will be Jeanette Vazquez.

Infant program will operate at the Izzi Main Office in the Doctor Jean Vankuelen classroom. Main entrance to infant program will be through the Easton Avenue, parking lot entrance. The facility will operate Monday through Friday 8:00am to 4:30pm. Infant component includes a lobby, director's office, 1 children's restroom, teacher's preparation/kitchenette area, and an outdoor area.

LPAs inspected day care areas for health and safety hazards and measured day care areas.

Infant Indoor measurements are:
There is 1 classroom for the infant component. The indoor area contains a total of 384.51 square feet which will accommodate applicant's request for 9 infants.

Infant Outdoor measurements are:
There is 1 outdoor area for the infant component. The outdoor area contains a total of 830.90 square feet which will accommodate applicant's request for 9 infants. No outdoor rotation waiver is needed.

Infant sinks and toilets:
There are 3 sinks and 1 toilet available for infants' use. Toilet and sink ratio is sufficient to accommodate applicant's request for 9 infants.
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NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/15/2026
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 5
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: IHSD, INC.-SAN BRUNO
FACILITY NUMBER: 414005288
VISIT DATE: 05/15/2026
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The child care center was observed to be clean, sanitary and in good repair. A comfortable temperature for children is being maintained. There are heater and air conditioning ventilation systems in the classroom, that are high, inaccessible to children. Furniture and equipment were observed to be maintained in good condition. Tables and chairs are age appropriate. There are rugs in the classroom that were observed to be clean, new and free of stains. Per representative, rugs will be vacuumed daily and deep cleaned quarterly.
Children's toys and materials will be sanitized daily in facility's dishwasher.

There is a teacher's preparation/kitchenette area in the classroom that is to be off limits to children. Preparation area includes a half door, laundry system and refrigerator. LPAs observed cabinets and drawers in preparation area to include child safety locks. Per representative, door will also have a child safety door handle.

There is 1 child's restroom in the classroom. LPAs observed restroom to be in working condition. There is a diaper changing table in the restroom that is within arm's reach to an adult sink. LPAs observed changing table to be equipped with moisture resistant material and with sides of the changing table that is at least 3" high. Diapers and wipes are provided by the program. Diapering sinks are not used for meal preparation or dishwashing. LPAs observed garbage bins with tight fitting lids throughout the facility. Sinks accessible to children do not provide water that is warmer than 120 degrees Fahrenheit.

Classroom does not have a separate napping space for infants. Program plans to enroll children over 12 months only who are capable of climbing out of a crib. Infants will sleep in the classroom on cots. LPAs observed cots to be stored appropriately, when not in use. LPAs also observed cots to be labeled with children's individual names. Program plans to provide children with sheets, families will provide blankets. Blankets will be stored in children's individual cubbies so that they are not touching each other. Per representative, sheets will be laundered on site daily.

LPA discussed the safe sleep regulations with facility representative and discussed the Child Care Licensing Safe Sleep webpage at:https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep, as an additional resource. LPA also informed facility representative of the importance of checking for and removing 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.
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NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2026
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: IHSD, INC.-SAN BRUNO
FACILITY NUMBER: 414005288
VISIT DATE: 05/15/2026
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Infant classroom is equipped with multiple first aid kits, fully charged fire extinguisher, smoke detectors and carbon monoxide detectors. Carbon monoxide detector was tested during today's visit and was observed to be in working condition. Facility is also equipped with a fire alarm system, sprinklers and emergency materials. When medications are on site, they will be stored in the teachers' preparation area in a high cabinet. A refrigerator is available for medication that may need to be refrigerated.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes 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

Licensing documents are posted in the classroom, available for review. Children will be signed in and out program with electronic signatures. Per representative, sign in and out sheets will be maintained for at least 30 days. There is sufficient cubby space for children's personal belongings.

Outdoor area is located directly outside the infant classroom and is fully enclosed and fenced. LPAs observed outdoor area to include tricycles and a variety of outdoor toys and materials that are in good condition. Flooring in outdoor area includes concrete, artificial turf and tanbark cushion. LPAs did not observe any pools, spas or bodies of water on site.

Program will provide a food service that includes morning snack, lunch and afternoon snack. Reusable dishes and materials will be utilized and sanitized daily through facility's dishwasher on site. Program may utilize disposable materials in the future. Food will be delivered to the facility daily through a third party vendor and will be prepared in teacher's preparation area.

Drinking water is available with a water container that will be refilled on site through water stations and/or sinks. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).
LPA reviewed with facility representative, the LIC 311A, Records to Be Maintained at The Facility, for child’s records, personnel records, administrative records, and documents to be posted.
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NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2026
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: IHSD, INC.-SAN BRUNO
FACILITY NUMBER: 414005288
VISIT DATE: 05/15/2026
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Representative 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 athttps://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication

If you have any questions regarding the process or CARE tools, please send email inquiries 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

Facility representative was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides 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 Child Care Center. 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.

Facility will be approved for a total capacity of 9 infants upon Centralized Application Bureau (CAB) final approval of application.

Exit interview conducted and report was reviewed with the facility representative, Jennifer Pifeleti.
NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2026
LIC809 (FAS) - (06/04)
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