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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001195
Report Date: 08/09/2024
Date Signed: 08/09/2024 04:40:57 PM

Document Has Been Signed on 08/09/2024 04:40 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:1ST PLACE 2 STARTFACILITY NUMBER:
384001195
ADMINISTRATOR/
DIRECTOR:		SANDRA DAVISFACILITY TYPE:
850
ADDRESS:1252 SUNNYDALE AVETELEPHONE:
(415) 333-2659
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94134
CAPACITY: 27TOTAL ENROLLED CHILDREN: 17CENSUS: 14DATE:
08/09/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:58 PM
MET WITH:Sandra DavisTIME VISIT/
INSPECTION COMPLETED:
04:55 PM
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C1 = the child

On August 09, 2024 at approximately 02:55 PM, Licensing Program Analyst (LPA) Tso conducted an unannounced, case management visit. LPA met with Director, Sandra Davis, and explained the purpose of the visit. Present in the facility is director, 4 staff, and 14 children in care.

The case management visit is regarding an unusual incident occurred. Facility self-reported incident to CCLD on August 02, 2024. Without the date of the incident happened reported, a student volunteer disclosed during the conversation the Director that the student volunteer had seen a teacher use hand in a striking motion on C1.

LPA interviewed with C1, 2 teachers and the Director. There was no sufficient evidence found to the incident.
There were no deficiencies cited at this time under CCR, Title 22, Div. 12, Chapter 3. A copy of today’s report was given to the Director.

Notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Director, Sandra Davis.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Man Tso
LICENSING EVALUATOR SIGNATURE: DATE: 08/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/09/2024
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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