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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 213006108
Report Date: 02/29/2024
Date Signed: 02/29/2024 04:06:50 PM


Document Has Been Signed on 02/29/2024 04:06 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:C.A.M. (CFS) SAN PEDRO (PS)FACILITY NUMBER:
213006108
ADMINISTRATOR:LOMBARDI, KELSEYFACILITY TYPE:
850
ADDRESS:498 POINT SAN PEDRO ROADTELEPHONE:
(415) 485-2450
CITY:SAN RAFAELSTATE: CAZIP CODE:
94901
CAPACITY:40CENSUS: 11DATE:
02/29/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:31 PM
MET WITH:Sheila VicenteTIME COMPLETED:
04:20 PM
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On 2/29/2024, Licensing Program Analyst (LPA) Hanson Leong conducted an unannounced case management visit to the child care center listed above. The purpose of the visit was to investigate an incident that occurred on 1/22/2024 involving a child (C1) and two staff members (S1 & S2). During today’s visit, the LPA met the facility representative, Sheila Vicente. The facility representative was informed of the reason for today's visit by the LPA. During today's visit, eleven preschool-aged children were present in the center. Present in the center with fingerprint clearance included the four staff members. The center is operating within its capacity and in accordance with the required ratio of staff to children.

Following the incident, S1 and S2 were placed on administrative leave by the licensee's Human Resources (HR) department. Based on a review of S1 and S2’s emails, the LPA found their HR department completed an internal investigation and their HR could not validate the allegation involving C1. Both S1 and S2 have since returned to work.

After reviewing the information from today's visit, the LPA will close out the incident that took place on 1/22/2024.
No deficiencies were issued today during LPA's visit.

A copy of today’s report was given to Sheila Vicente.

A Notice of Site Visit was given and must remain posted for 30 days.


Exit interview conducted and report was reviewed with Sheila Vicente.
SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson LeongTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 02/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/29/2024
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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