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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
384004785
Report Date:
10/25/2023
Date Signed:
10/26/2023 10:00:30 AM
Document Has Been Signed on
10/26/2023 10:00 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:
BELTRAN, JAQUELINE B.
FACILITY NUMBER:
384004785
ADMINISTRATOR:
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
CITY:
STATE:
ZIP CODE:
CAPACITY:
8
TOTAL ENROLLED CHILDREN:
8
CENSUS:
0
DATE:
10/25/2023
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
08:50 AM
MET WITH:
Jaqueline Beltran
TIME COMPLETED:
11:06 AM
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SUPERVISORS NAME
:
Daniel J Oquendo
LICENSING EVALUATOR NAME
:
Sheran Lo
LICENSING EVALUATOR SIGNATURE
:
DATE:
10/25/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/25/2023
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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