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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 210110748
Report Date: 07/09/2024
Date Signed: 07/09/2024 10:12:19 AM

Document Has Been Signed on 07/09/2024 10:12 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:PAPERMILL CREEK CHILDREN'S CORNERFACILITY NUMBER:
210110748
ADMINISTRATOR/
DIRECTOR:		LOURDES ROMOFACILITY TYPE:
850
ADDRESS:503 B STREETTELEPHONE:
(415) 663-9114
CITY:PT. REYES STATIONSTATE: CAZIP CODE:
94956
CAPACITY: 35TOTAL ENROLLED CHILDREN: 25CENSUS: 10DATE:
07/09/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:07 AM
MET WITH:Lourdes RomoTIME VISIT/
INSPECTION COMPLETED:
10:25 AM
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On 7/9/2024, Licensing Program Analysts (LPAs) Leong and Van conducted an unannounced case management visit to the Child Care Center (CCC) listed above. The purpose of the visit was to follow up on an incident involving a child that occurred on 6/27/2024. LPAs met with the Director, Lourdes Romo, and explained the purpose of the visit. Ten preschool-aged children and seven staff members were present during the visit. The seven staff members present at the CCC received criminal record clearance from the department. The CCC is within its capacity limits and ratio.

LPAs interviewed S1 who was involved and a witness and found the child was being playful. According to the director, the child was flopping around, and S1 prevented the child from falling. According to the director, a similar incident happened during the graduation ceremony with the father observing the child being playful.

Based on the staff interview and the incident report, the department determined that the child’s personal rights were not violated. According to the director, she met with staff on the same day of the incident regarding children’s personal rights.

A copy of today’s report was given to the director, Lourdes Romo. A Notice of Site Visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Director, Lourdes Romo.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE: DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/09/2024
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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