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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004299
Report Date: 03/21/2025
Date Signed: 03/21/2025 12:28:21 PM

Document Has Been Signed on 03/21/2025 12:28 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:STS. PETER AND PAUL-LAURA VICUNA PRE-KINDERGARTENFACILITY NUMBER:
384004299
ADMINISTRATOR/
DIRECTOR:		SIMONS, BARBARAFACILITY TYPE:
850
ADDRESS:620 FILBERT STREETTELEPHONE:
(415) 296-8549
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94133
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 20DATE:
03/21/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:45 AM
MET WITH:Barbara Simons & Jessyca NgTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
NARRATIVE
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On March 21, 2025 at approximately 11:45am, Licensing Program Analyst (LPA) Ly conducted an Unannounced Case Management Visit and met with Site Director, Barbara Simons and Assistant Director Jessyca Ng during the visit. Purpose of the inspection was explained. There were 4 staff caring for 20 children during today's visit.


Today's visit is to follow up on a self reported incident reported to Licensing on 03/07/2025. Based on interviews with the Site Director and Assistant Director, facility had follow all safety protocol when incident took place. Facility representatives had kept a close communication with the involve child's family regarding the incident. Child had since returned to the program.


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 Assistant Director whose signature on this form confirm receipt of these reports. Notice of Site Visit was provided. 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: 03/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/21/2025
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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