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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380504442
Report Date: 07/29/2024
Date Signed: 07/29/2024 04:33:11 PM

Document Has Been Signed on 07/29/2024 04:33 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:SFUSD-NORIEGA EARLY EDUCATION SCHOOL (PS)FACILITY NUMBER:
380504442
ADMINISTRATOR/
DIRECTOR:		NG, IVYFACILITY TYPE:
850
ADDRESS:1775 - 44TH AVENUETELEPHONE:
(415) 759-2853
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94122
CAPACITY: 136TOTAL ENROLLED CHILDREN: 136CENSUS: 67DATE:
07/29/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Principal Ivy NgTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
NARRATIVE
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On July 29, 2024 at approximately 2:30pm, Licensing Program Analyst (LPA) Ly conducted an Unannounced Case Management Visit for a self reported Unusual Incident that was reported to the department on 07/25/2024. LPA met with Principal, Ivy Ng during the visit. Purpose of the inspection was explained. There were 15 staff caring for 67 children during the visit.

During today's visit, LPA interviewed the Principal to obtain detail information into the Unusual Incident. Per Principal, the school has launched an internal investigation to the incident and is still continuing to meet with involved parties.

During today's visit, LPA have collected a written Unusual Incident/Injury Report (LIC 624) from Principal Ng. School Principal has been advised to submit all investigation documents and result to Licensing once investigation is complete.

This incident needs further investigation and follow up.

A copy of this report and appeal rights were discussed and left with Director whose signature on this form confirm receipt of these reports. Notice of Site Visit was posted. Notice to remain posted for 30 days.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Winnie Ly
LICENSING EVALUATOR SIGNATURE: DATE: 07/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/29/2024
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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