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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410505762
Report Date: 02/21/2023
Date Signed: 02/21/2023 09:45:36 AM


Document Has Been Signed on 02/21/2023 09:45 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:INTERCOMMUNAL SURVIVAL SCHOOLFACILITY NUMBER:
410505762
ADMINISTRATOR:CAMACHO, MELINDA ANNFACILITY TYPE:
850
ADDRESS:713 SECOND AVENUETELEPHONE:
(650) 347-0463
CITY:SAN MATEOSTATE: CAZIP CODE:
94401
CAPACITY:29CENSUS: 11DATE:
02/21/2023
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Melina CamachoTIME COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA) Marie Rodriguez made a scheduled follow up case management visit and met with Director Melinda "Mindy" Camacho. Present at the facility were the Director, two teachers, one teacher's assistant, and 11 preschool aged children. LPA was asked to inspect Deer classroom since repairs have been completed.

LPA inspected Deer classroom for health and safety hazards. Classroom has new flooring and walls have been repaired and repainted. Classroom has age appropriate toys and equipment. LPA remeasured the Deer classroom for a total of 421.68 sq ft divided by 35 sq ft equals a total capacity of 12 children. Total capacity for the school remains at 29 children.

LPA is approving the use of the Deer classroom pending fire inspector's inspection. Annual inspection will be conducted this morning at 10am.

No deficiencies cited today under California Code of Regulations, Title 22, Division 12.

Exit interview conducted and report was reviewed with Director Mindy Camacho. A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 02/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/21/2023
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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