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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005192
Report Date: 03/07/2024
Date Signed: 03/07/2024 10:13:07 AM


Document Has Been Signed on 03/07/2024 10:13 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:C.A.M. (CFS) -CANAL CHILD CARE CENTER (PS)FACILITY NUMBER:
214005192
ADMINISTRATOR:XIAOLI RODRIGUESFACILITY TYPE:
850
ADDRESS:215 MISSION AVENUETELEPHONE:
(415) 526-7500
CITY:SAN RAFAELSTATE: CAZIP CODE:
94901
CAPACITY:44CENSUS: 33DATE:
03/07/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:58 AM
MET WITH:XiaoLi RodriguesTIME COMPLETED:
10:25 AM
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On March 7, 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 February 12, 2024, involving a child (C1) and a staff member (S1). During today’s visit, the LPA met the Director, XiaoLi Rodrigues. The director was informed of the reason for today's visit by the LPA. During today's visit, thirty-three preschool-aged children were present in the center. Present in the center with fingerprint clearance included the director and eight staff members. The center is operating within its capacity and in accordance with the required ratio of staff to children.

According to the director, an incident involving S1, who allegedly grabbed C1 by the wrist, was not reported immediately. The staff member who reported the incident, S2, waited two weeks before informing the director. Currently, the HR department is still investigating the incident, and as a result, S1 is on paid administrative leave.

LPA will closely monitor the situation until the HR investigation is completed. The director was advised to inform the department as soon as the investigation concludes.

A copy of today’s report was given to XiaoLi Rodrigues.
A Notice of Site Visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with XiaoLi Rodrigues.
SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson LeongTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/07/2024
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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