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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
414002826
Report Date:
04/27/2023
Date Signed:
04/27/2023 05:04:03 PM
Document Has Been Signed on
04/27/2023 05:04 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:
CRUZ, CHRISTIE T.
FACILITY NUMBER:
414002826
ADMINISTRATOR:
CRUZ, CHRISTIE T.
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(650) 278-6163
CITY:
SOUTH SAN FRANCISCO
STATE:
CA
ZIP CODE:
94080
CAPACITY:
14
CENSUS:
5
DATE:
04/27/2023
TYPE OF VISIT:
POC
UNANNOUNCED
TIME BEGAN:
03:50 PM
MET WITH:
Christie Cruz
TIME COMPLETED:
05:10 PM
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Licensing Program Analyst (LPA) Andrea Medlin met with facility representative for this plan of correction visit established on 1/20/2023. There are 5 children present during the visit; 3 infants and 2 preschool aged. The following deficiencies previously cited are observed to be corrected and cleared:
Section
102416.5(b)(1)
- Staffing ratio and capacity - Licensee is in compliance as now within ratio and licensed capacity. A list of children's names and birthdays obtained during visit.
Health and Safety Code
1596.8662(b)(1)
- California Child Abuse Mandated Reporter training is now complete and expires 2/4/2025.
This report is reviewed with Licensee and a copy of this report must be made available for public review upon request.
Notice of site visit posted during visit.
SUPERVISOR'S NAME:
Daniel J Oquendo
TELEPHONE:
(650) 266-8800
LICENSING EVALUATOR NAME:
Andrea Medlin
TELEPHONE:
650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE:
04/27/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
04/27/2023
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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