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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 213005570
Report Date: 11/08/2023
Date Signed: 11/08/2023 10:18:27 AM

Document Has Been Signed on 11/08/2023 10:18 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:OLD FIREHOUSE SCHOOL MILL VALLEY-PRESCHOOLFACILITY NUMBER:
213005570
ADMINISTRATOR:GARRETT O'BRIENFACILITY TYPE:
850
ADDRESS:10 OLIVE STREETTELEPHONE:
(415) 388-1417
CITY:MILL VALLEYSTATE: CAZIP CODE:
94941
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 25DATE:
11/08/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Garrett O'BrienTIME COMPLETED:
10:20 AM
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On 11/8/2023, Licensing Program Analyst (LPA) Hanson Leong, made an unannounced case management visit to the child daycare facility listed above. The LPA was granted entry by the Director, Garrett O’Brien. The purpose of the visit was to confirm whether a possible personal rights incident involving a child occurred on 10/12/2023. The LPA explained the purpose of the visit to Mr. O’Brien. Present in the facility: Mr. O’Brien, 6 staff members and 25 preschool aged children. All individuals listed on the facility’s roster have been granted permission to work or be present in a childcare facility. The facility is operating within its capacity and in accordance with the required ratio of staff to children.

The LPA interviewed Mr. O’Brien regarding the personal rights incident on 10/12/2023. According to Mr. O’Brien, he spoke to the staff member involved with this personal rights incident and went over the personal rights regulation with the staff member. After the LPA’s interview with Mr. O’Brien, the LPA determined that there was no personal rights violation involving that child on 10/12/2023.

No deficiencies were cited today under CCR, Title 22, Div. 12.

A copy of today’s report was given to Garrett O’Brien. The Notice of Site Visit was given to Garrett O’Brien and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Exit interview conducted and report was reviewed with Garrett O’Brien.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE: DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2023
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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