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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410517246
Report Date: 03/23/2023
Date Signed: 03/23/2023 11:43:02 AM

Document Has Been Signed on 03/23/2023 11:43 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:TEMPORARY TOT TENDING #3FACILITY NUMBER:
410517246
ADMINISTRATOR:PASTOR, YVONNEFACILITY TYPE:
850
ADDRESS:350 DOLORES WAYTELEPHONE:
(650) 588-0128
CITY:SOUTH SAN FRANCISCOSTATE: CAZIP CODE:
94080
CAPACITY: 56TOTAL ENROLLED CHILDREN: 56CENSUS: DATE:
03/23/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Yvonne PastorTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Andrea Medlin met with facility representative for this case management due to an incident. On 2/23/2023, a teacher was doing a project with a few children involving drawing a collage using quarters. Without warning,a child (C1) took one of the quarters and put in his mouth. The child end up swallowing the quarter; Staff tried to get it out but was unable. The parent was called and child taken to the hospital where a procedure was done and quarter was removed. This appears to have been an isolated incident and an accident. Staff no longer have real money in the classrooms.

This report is reviewed with facility representative and a copy of this report must be made available for public review upon request.

Notice of Site Visit posted and shall remain posted for 30 days.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Andrea Medlin
LICENSING EVALUATOR SIGNATURE: DATE: 03/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/23/2023
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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