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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380505534
Report Date: 10/30/2023
Date Signed: 10/30/2023 04:14:35 PM

Document Has Been Signed on 10/30/2023 04:14 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:FAMILY DEVELOPMENTAL CENTER (INFANT)FACILITY NUMBER:
380505534
ADMINISTRATOR:BELL, EBONYFACILITY TYPE:
830
ADDRESS:2730 BRYANT STREETTELEPHONE:
(415) 282-1090
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY: 95TOTAL ENROLLED CHILDREN: 95CENSUS: 44DATE:
10/30/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Dee LeeTIME COMPLETED:
04:20 PM
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On 10/30/2023 at 12:15PM., Licensing Program Analyst (LPA) Luis J. Gomez met with Administrator, Mindy Camacho. Purpose of the inspection was explained and was for an unannounced; Plan of Correction inspection. Administrative Director, Dee Lee arrived during inspection. Present was the administrative director and 15 caring for 44 children. All staff have criminal record clearances on file. Children present had been properly signed in. LPA inspected facility for health and safety hazards.

During inspection, LPA performed observations, record review and interviews.

At 12:25AM., LPA inspected classrooms. Classroom were clean and orderly. Floors and ground surfaces were clear of obstructions or possible hazards. Per administrative director, deep cleaning has been completed in all the infant/ toddler classrooms.

Per director, for pest mitigation, additional traps have been set up around building. During inspection, LPA observed accessible holes and broken door sweeps in play yard have been repaired or replaced.

Deficiencies issued on 9/20/2023, has been cleared and ‘Cleared Plan of Correction Letters’ were provided.

Based on today's inspection, no deficiencies were observed in the areas evaluated according to the Title 22 Division 12 Ca. Code of Regulations. Exit interview, and report was discussed with Administrative Director, Dee Lee, and signature of this form acknowledges receipt of these documents.

This report must be available in the facility for public review. Notice was provided and shall remain posted for 30 days. Licensee was advised for additional questions to call CCL Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 10/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/30/2023
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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