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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380504384
Report Date: 05/16/2023
Date Signed: 05/16/2023 09:43:09 AM

Document Has Been Signed on 05/16/2023 09:43 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:SFUSD-RAPHAEL WEILL (EES) PRESCHOOLFACILITY NUMBER:
380504384
ADMINISTRATOR:DARREN KAWAIIFACILITY TYPE:
850
ADDRESS:1501 O'FARRELL STREETTELEPHONE:
(415) 749-3548
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94115
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 18DATE:
05/16/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Agrinilda WaideTIME COMPLETED:
10:00 AM
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On May 16, 2023, at approximately 8:40am, Licensing Program Analyst (LPA) arrived at facility to conduct Unaccounted Case Management inspection due to a self reported incident reported to the department on 05/03/2023. On this day, LPA met with Lead Teacher, Agrinilda Waide. Purpose of the inspection was explained. There were 18 children and 4 staff including the Lead Teacher present during today's visit.


Per incident report and information collected, the incident happened in the yard during the dismissal of the Transitional Kindergarten class and prior to the child being transitioned to the child's afternoon Pre-K classroom. Information collected also revealed The staff involved in the incident is currently on Administrative Leave Pending Internal Investigation. LPA will conduct follow up visit or Facility Administrators will be contacted regarding the internal investigation.


A copy of this report and appeal rights were discussed and left with Lead Teacher whose signature on this form confirm receipt of these reports. Notice of Site Visit was provided. Notice to remain posted for 30 days. For updates on Licensing information, go to CCL website: www.ccld.ca.gov. For Provider Information Notice: ccld.ca.gov/PG5098.htm
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Winnie Ly
LICENSING EVALUATOR SIGNATURE: DATE: 05/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/16/2023
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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