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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380505568
Report Date: 06/16/2025
Date Signed: 06/16/2025 03:00:38 PM

Document Has Been Signed on 06/16/2025 03:00 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 (PRESCHOOL)FACILITY NUMBER:
380505568
ADMINISTRATOR/
DIRECTOR:		QUIROZ, YOHANAFACILITY TYPE:
850
ADDRESS:2730 BRYANT STREETTELEPHONE:
(415) 282-1090
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY: 83TOTAL ENROLLED CHILDREN: 83CENSUS: 50DATE:
06/16/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:20 PM
MET WITH:Senior director, Olabisi AdesuyifasuyiTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
NARRATIVE
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On June 16, 2025 at approximately 1:20pm, Licensing Program Analysts (LPA) Melissa Zaragoza conducted an unannounced, case management visit to Family Developmental Center (Preschool). LPA met with senior director, Olabisi Adesuyifasuyi, and explained the purpose of the visit. Present during LPA's visit included 15 teaching staff and 50 children present. Facility is operating within capacity limits and ratio during LPA's visit. Teaching staff present have fingerprint clearance on file. Childcare centers hours of operation are Monday through Friday, from 7:30am to 4:30pm.

LPA conducted a visit in regard to an unusual incident's report that was reported to the department. The unusual incident was reported on June 10, 2025. The incident involves Child C1, and staff members S1, S2, S3 and S4. On 06/03/2025 at around 11:50 AM, the bumble bee class was transitioning to lunch. Per senior director, while classroom went inside, C1 hid in a blind spot area. Per senior director, S1 observed if there were any children left behind, and did not observe anyone. Per senior director, S1 closed the door, and C1 was left outside for a couple of minutes. Per senior director, minutes later S2 was walking down the hall, coming from the bathroom, and spotted C1. Per senior director, S3 was walking to the classroom, and also spotted C1. Per senior director, S3 took C1 into the classroom immediately. Per senior director, they conducted an investigation, and staff members involved in the incident wrote a statement of what happened. Per senior director, parents were unable to be informed about the incident because C1 is on vacation.

Per senior director, lead teacher in the class, S4 got a formal reprimand and S1 was placed on unpaid administrative leave for 20 days. Per senior director, the classroom teacher went over policies and procedures with all staff members in the class. Per senior director, every quarter they send out a reminder memo on proper supervision, and additional supervision training is conducted every quarter.

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NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Melissa Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/16/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 (PRESCHOOL)
FACILITY NUMBER: 380505568
VISIT DATE: 06/16/2025
NARRATIVE
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(Page 2 Continued...)

Due to reported violation, a Type B deficiency has been issued. Please see LIC 809D for more details.

Deficiencies were cited today under CCR, Title 22, Div. 12, Chapt. 1.

This report must be available in the facility for public review.

A notice of site visit shall be posted for 30 days from today's visit.

An exit interview was conducted with the senior director, Olabisi Adesuyifasuyi.
NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Melissa Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/16/2025 03:00 PM - It Cannot Be Edited


Created By: Melissa Zaragoza On 06/16/2025 at 02:43 PM
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 (PRESCHOOL)
FACILITY NUMBER: 380505568

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/16/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/16/2025
Section Cited
CCR
101229(a)(1)

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101229: Responsibility for Providing Care and Supervision: (a) "The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time... Supervision shall include visual observation."

This requirement was not met as evidenced by:
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The action plan has been modified to take disciplinary action. Staff in classrooms have received formal reprimands and suspension.
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Based on interview and record review, the facility did not comply with the section cited above as facility self reported that there was a child left alone inside the classroom #1 during outdoor play, which poses an immediate health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Marie Rodriguez
NAME OF LICENSING PROGRAM MANAGER:
Melissa Zaragoza
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/16/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/16/2025


LIC809 (FAS) - (06/04)
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