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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004755
Report Date: 08/21/2023
Date Signed: 08/21/2023 08:53:39 AM

Document Has Been Signed on 08/21/2023 08:53 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:SHU, CHUNHUAFACILITY NUMBER:
384004755
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
08/21/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Chunhua ShuTIME COMPLETED:
09:05 AM
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On August 21, 2023 at 8:20 AM, Licensing Program Analyst (LPA) Cowan met with applicant for an announced subsequent Pre-Licensing inspection. Present in the home is applicant and her adult son. During the previous Pre-Licensing inspection, applicant had not totally moved in to the apartment. Applicant stated during last inspection that she would be totally moved in by 8/21/23. On this day, LPA observed applicant has belongings in the closets and bathrooms.

Before applicant may be licensed, all adults in the home must receive a fingerprint clearance.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: April Cowan
LICENSING EVALUATOR SIGNATURE: DATE: 08/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/21/2023
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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