<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004486
Report Date: 10/09/2024
Date Signed: 10/09/2024 10:42:02 AM

Document Has Been Signed on 10/09/2024 10:42 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:LITTLE ANGELS JAPANESE PRESCHOOLFACILITY NUMBER:
384004486
ADMINISTRATOR/
DIRECTOR:		HIRAI, HISAMIFACILITY TYPE:
850
ADDRESS:2545 JUDAH STREETTELEPHONE:
(415) 564-6123
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94122
CAPACITY: 12TOTAL ENROLLED CHILDREN: 3CENSUS: 2DATE:
10/09/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Hisami HiraiTIME VISIT/
INSPECTION COMPLETED:
10:00 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On October 09, 2024 at approximately 8:30AM, Licensing Program Analyst (LPA) Ly conducted an Unannounced Plan of Correction (POC) Visit at the facility. Facility was locked and no one was present. LPA waited until approximately 9:00AM, Director Hisami Hirai and her husband arrived. Purpose of the inspection was explained. There were 2 children arriving soon after.

The POC visit is regarding Type B deficiency cited on 07/29/2024:
The licensee shall ensure that a separate, complete and current record for each child is maintained in the child care center. Children's files were not complete. All children files did not have required licensing forms.

During today's visit, LPA reviewed children's files. Children's files have emergency contact information, required licensing forms and immunization record. LPA cleared the deficiency by visit and issued a letter of clearance to facility Director.


A copy of this report and appeal rights were discussed and left with 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: 10/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/09/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1