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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004598
Report Date: 04/23/2024
Date Signed: 04/23/2024 04:33:13 PM

Document Has Been Signed on 04/23/2024 04:33 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 CENTERFACILITY NUMBER:
384004598
ADMINISTRATOR/
DIRECTOR:		CASTILLO, MELISSAFACILITY TYPE:
850
ADDRESS:2050 FOLSOM STREETTELEPHONE:
(415) 401-4253
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 27DATE:
04/23/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Giovanni Portillo, Melissa Castillo TIME VISIT/
INSPECTION COMPLETED:
04:40 PM
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On 4/23/2024 at 2:30PM., Licensing Program Analyst (LPA) Luis Gomez and met with Staff, Giovanni Portillo. The purpose of today’s inspection was explained and was for an unannounced, plan of correction inspection established on 4/11/2024. Director, Melissa Castillo. Present was 7 staff caring for 27 children. LPA inspected facility for health and safety hazards.

During inspection, LPA conducted record review, observations, and interviews.

At 2:35PM., LPA observed the following: classroom storage cabinets have child safe locks. Per staff, cabinets will remain locked at all times. Storage of detergents will be located in off-limit areas.
At 3:20PM., LPA reviewed facility records. LPA observed staff, S5, has received criminal record clearance and association.

The signed LIC9224, Notice of A-type deficiency was observed in the children’s files.
Notice of Site Visit was observed posted in facility lobby.

Based on today's inspection, no deficiencies were observed in the areas evaluated according to the Title 22 Division 12, Chap 1. Ca. Code of Regulations. Exit interview, facility evaluation report was discussed with Director, Melissa Castillo. Staff’s signature of this form acknowledges receipt of these documents.

This report must be available in the facility for public review. Notice was provided and shall remain posted for 30 days. The licensees were advised for additional questions to call CCL Office, M-F, 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: 04/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/23/2024
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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