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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380504406
Report Date: 08/05/2024
Date Signed: 08/05/2024 02:21:53 PM


Document Has Been Signed on 08/05/2024 02:21 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:SFUSD-SAN MIGUEL EARLY EDUCATION SCHOOL (PS)FACILITY NUMBER:
380504406
ADMINISTRATOR:ANITA TONG, DIRECTORFACILITY TYPE:
850
ADDRESS:300 SENECA AVENUETELEPHONE:
(415) 469-4756
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94112
CAPACITY:102CENSUS: DATE:
08/05/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Anna HuTIME COMPLETED:
02:30 PM
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Licensing Program Analyst, LPA Yee conducted a case management visit today. Present at the facility are 12 staff members and 68 children. This is a self-reported incident.

On June 13th, a child had an accident, and the teacher helped the child change from wet to dry clothes. Then, the child informed the mom at home that the teacher padded her. There were no witnesses at the time of the incident. The school interviewed the staff who were involved in the incident. The school outcome of the investigation is inclusive. LPA cannot speak to the staff because the staff is on vacation. Today, LPA spoke on the phone with the substitute principal, Mr. Hollands, who was on site on the day of the incident. Based on the information obtained from today's visit, there was no violation at the time of the incident.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 08/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/05/2024
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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