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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004713
Report Date: 06/20/2023
Date Signed: 06/20/2023 04:11:01 PM

Document Has Been Signed on 06/20/2023 04:11 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:BANOS, KAREN Y.FACILITY NUMBER:
384004713
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
06/20/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Karen Y. BanosTIME COMPLETED:
04:30 PM
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Licensing Program Analysts (LPA) Yee conducted a case management inspection today. The facility requested an increase in capacity for a large FCCH. LPA and Licensee toured the daycare areas. This is a single-family home. Present at the facility are the licensee, Karen Banos, her mom, and 2 daycare children. The facility personnel summary report was reviewed with Karen and she said it is current. All adults living or working in the home have criminal background checks on file. Current residents at the facility are Karen, her mom, her sister, and her children ages 13 years old and 17 years old.

Day Care Areas (lower level): Upper Level: Living Room (Playroom #1), Family Room (Playroom #2), and Bathroom #1. The remaining areas are off-limit.

A capacity worksheet for large FCCH was explained and provided.

Prior to approval for a large license, fire clearance approval is needed.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jennifer Yee
LICENSING EVALUATOR SIGNATURE: DATE: 06/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/20/2023
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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