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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384000944
Report Date: 02/06/2024
Date Signed: 02/07/2024 07:30:37 AM

Document Has Been Signed on 02/07/2024 07:30 AM - 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:LONE MOUNTAIN CHILDREN'S CENTERFACILITY NUMBER:
384000944
ADMINISTRATOR:GRILLO, JACQUEFACILITY TYPE:
850
ADDRESS:1806 BELLES STREET-SF PRESIDIOTELEPHONE:
(415) 876-0057
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94129
CAPACITY: 72TOTAL ENROLLED CHILDREN: 72CENSUS: 62DATE:
02/06/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Jacque GrilloTIME COMPLETED:
12:15 PM
NARRATIVE
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On February 06, 2024 at approximately 11:30am, Licensing Program Analyst (LPA) Ly conducted an Unannounced Case Management Visit into an Unusual Incident that was reported to the department on 01/23/2024. LPA met with Site Executive Director, Jacque Grillo during the visit. Purpose of the inspection was explained. There were 12 staff caring for 62 children during the visit. Teacher to child ratios were met on this day.



No deficiencies were issued today under Title 22 Division 12 of the California Code of Regulations. A copy of this report and appeal rights were discussed and left with Executive Director whose signature on this form confirm receipt of these reports. Notice of Site Visit was posted. Notice to remain posted for 30 days. For updates on Licensing information, go to CCL website: www.ccld.ca.gov. For Provider Information Notice: ccld.ca.gov/PG5098.htm
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Winnie Ly
LICENSING EVALUATOR SIGNATURE: DATE: 02/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2024
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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