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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384000227
Report Date: 03/13/2025
Date Signed: 03/13/2025 01:09:15 PM

Document Has Been Signed on 03/13/2025 01:09 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/
DIRECTOR:		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: 19DATE:
03/13/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:05 PM
MET WITH:Lilian Sanchez, Mary GastonTIME VISIT/
INSPECTION COMPLETED:
01:20 PM
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On 3/13/2025 at 12:05PM., Licensing Program Analyst (LPA) Luis Gomez and met with Site Supervisor, Liliana Sanchez. Purpose of inspection was explained and was for an unannounced, plan of correction inspection established on 2/27/2025. Child Development Center Director, Mary Gaston arrived during inspection. Present were the Site Supervisor and 5 staff supervising 19 children. Children present had been signed in by Guardians. LPA inspected facility for health and safety hazards.

During inspection, LPA conducted record review, observation, and interview.

At 12:10PM., LPA observed children’s sink has been repaired and is in operating condition. Children bathroom area was free of hazards or dangerous conditions.

Deficiencies issued has been cleared, letter was provided to director.

>No deficiencies were cited against the facility under CCR, Title 22, Division 12, Chapter 1.

This report must be available in the facility for public review. Notice was provided and shall remain posted for 30 days. Site Supervisor was advised for additional questions to call CCL Office, Mon-Fri, 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: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/13/2025
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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