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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004628
Report Date: 01/27/2020
Date Signed: 02/19/2020 11:05:46 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:MY BUSY TOWN LEARNING CENTERFACILITY NUMBER:
414004628
ADMINISTRATOR:PADILLA, TIFFANYFACILITY TYPE:
850
ADDRESS:556 SAN MATEO AVENUETELEPHONE:
(650) 515-4010
CITY:SAN BRUNOSTATE: CAZIP CODE:
94066
CAPACITY:60CENSUS: DATE:
01/27/2020
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Tiffany PadillaTIME COMPLETED:
04:45 PM
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An office meeting was conducted today in the San Bruno Regional Office. Present during the meeting is Regional Manager (Suzanne Roman-Clark), Licensing Program Analyst (Pandora Huffman-Smith), applicant (Tiffany Padilla), and applicant's husband (Alex Padilla). The purpose of the meeting is to discuss the pending application for drop-in care for preschool children (ages 2 to entry into first grade and school age children (ages 6-12 years). .

The Regional Manager, Suzanne Roman-Clark, reviewed the requirements of drop-in care including ratios, bathroom usage and any required waivers.

The facility will be issued waivers for; no outdoor space, sharing of bathroom, and commingling of preschool and school age children.

An amended application (LIC 200A) to change hours and final approval is required prior to licensure.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Pandora Huffman-SmithTELEPHONE: (650)266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2020
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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