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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384000227
Report Date: 03/13/2024
Date Signed: 03/13/2024 04:35:37 PM

Document Has Been Signed on 03/13/2024 04:35 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:GOOD SAMARITAN FAMILY RESOURCE CENTER CDCFACILITY NUMBER:
384000227
ADMINISTRATOR:T CARIAS/C BLOCK/B DIXONFACILITY TYPE:
850
ADDRESS:1294 POTRERO AVENUETELEPHONE:
(415) 824-9475
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY: 36TOTAL ENROLLED CHILDREN: 36CENSUS: 5DATE:
03/13/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Lilana SanchezTIME COMPLETED:
04:45 PM
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On 3/13/2024 at 4:00PM, Licensing Program Analyst (LPA) Luis Gomez met with Director, Liliana Sanchez. The purpose of the inspection was explained and was for an unannounced, plan of correction inspection established on 1/17/2024. Present was the director and two staff supervising 5 children. LPA inspected facility for health and safety hazards.

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


On 1/31/2024. Director submitted photos to the Department showing corrections made to staff bathroom/ storage room.

LPA observed the following: Staff bathroom/ Storage room door handle has been fixed. Area has been made inaccessible to children in care. Inside the staff bathroom, child safety lock has been installed on storage cabinet hold facility’s detergents, cleaning compound, and toxins. Per director, door to the off-limit area will remain locked while children are present.

Deficiency issued has been cleared, and ‘Cleared Plan of Correction Letter’ was provided.

Exit interview, and inspected report was discussed with Director, Liliana Sanchez. 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. Director was advised for additional questions to call CCL Office, M-F, 8:00am-5:00pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov

LPA was unable to print report during inspection. LPA will send report to facility at a later date.

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 03/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/13/2024
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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