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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380505534
Report Date: 09/20/2023
Date Signed: 09/20/2023 12:39:26 PM

Document Has Been Signed on 09/20/2023 12:39 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: 49DATE:
09/20/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Dee LeeTIME COMPLETED:
12:40 PM
NARRATIVE
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On 9/20/2023 at 8:45AM., Licensing Program Analyst (LPA) Luis J. Gomez met with Administrative Director, Dee Lee. Purpose of the inspection was explained. This case management report is to cite for deficiencies observed during complaint inspection. Present was the Director and 19 staff supervising 49 children. LPA inspected facility for health and safety hazards.

At 10:49AM., Based on observations, LPA confirmed rodent feces inside the Stars and Caterpillar Classrooms.



Based on today’s inspection, deficiencies were observed in areas evacuated according to the Title 22, Division 12, Chap, 1 of Ca, Code of Regulations and cited on the 809D. An exit interview, appeal rights, and plans for correction were discussed with the Administrative Director, Dee Lee and signature of this form acknowledges the receipt of these documents.

A copy of this report and appeal rights were reviewed and provided to the administrative director.
Notice of site visit was given and shall remain posted for 30 days.

LPA unable to print report during inspection. Report will be emailed to Administrative director.

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 09/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2023
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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Document Has Been Signed on 09/20/2023 12:39 PM - It Cannot Be Edited


Created By: Luis Gomez On 09/20/2023 at 11:59 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: FAMILY DEVELOPMENTAL CENTER (INFANT)
FACILITY NUMBER: 380505534

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/20/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/25/2023
Section Cited
CCR
101238(a)

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101238(a) Buildings and Grounds: The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. This requirement was not met as evidenced by:
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Facility will perform deep cleaning/ disinfecting of all infant toddler classrooms, including toys, accessible furniture, carpets, floors and surfaces by due date: 9/25/2023.
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At 10:49AM., Based on observations, LPA confirmed rodent feces inside the Stars and Caterpillar Classrooms. This poses a potential health and safety risk to children in care.
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Proof of correction will be submitted to the department via email.
Type B
09/25/2023
Section Cited
CCR101238(a)(1)

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101238(a)(1) Building and Grounds: (1) The licensee shall take measures to keep the center free of flies, other insects, and rodents. This requirement was not met as evidenced by:
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 Facility will install additional preventive measures to properly address and mitigate the on-going rodent issue by the due date: 9/25/2023.
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At 10:49AM., Based on observations, LPA confirmed rodent feces inside the Stars and Caterpillar Classrooms. The is poses a potential health and safety risk to children in care.
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Proof of correction will be submitted to he department via email.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Marie Rodriguez
LICENSING EVALUATOR NAME:Luis Gomez
LICENSING EVALUATOR SIGNATURE:
DATE: 09/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/20/2023


LIC809 (FAS) - (06/04)
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