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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005569
Report Date: 10/08/2024
Date Signed: 10/08/2024 04:21:03 PM

Document Has Been Signed on 10/08/2024 04:21 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:GOMES, ALINNEFACILITY NUMBER:
214005569
ADMINISTRATOR/
DIRECTOR:		GOMES, ALINNEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 858-4602
CITY:CORTE MADERASTATE: CAZIP CODE:
94925
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
10/08/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:16 PM
MET WITH:Alinne GomesTIME VISIT/
INSPECTION COMPLETED:
04:35 PM
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On October 8, 2024 at approximately 3:15pm, LPA Nathan Garcia conducted an unannounced, plan of correction visit (POC) to the facility. LPA met with licensee, Alinne Gomes, and explained the purpose of the visit. Present during LPA’s visit included 6 children with the licensee and helpers.

On September 27, 2024, LPA conducted an unannounced, annual visit at facility. During the visit, LPA observed that there were 4 infant children and 2 children at the age of two, with just one helper at the facility. Facility was issued a Type A citation and was cleared during the visit due to the licensee arriving from her appointment. A plan of correction and signed LIC9224s were discussed with Licensee.

Plan of correction was for licensee to ensure that ratio is met at all times.

As of this date, LPA observed completed LIC9224s for 7 enrolled children. LPA observed notice of site visit given during annual visit to be posted and available for review.

As of today's POC visit, the licensee is in compliance and the remaining deficiency of 15 minute sleep logs have been cleared and given to licensee.

Notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with licensee, Alinne Gomes.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Nathan Garcia
LICENSING EVALUATOR SIGNATURE: DATE: 10/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/08/2024
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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