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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004785
Report Date: 11/21/2023
Date Signed: 11/21/2023 10:28:45 AM

Document Has Been Signed on 11/21/2023 10:28 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: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
11/21/2023
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
08:49 AM
MET WITH:Jaqueline BeltranTIME COMPLETED:
11:05 AM
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On November 21, 2023, Licensing Program Analyst (LPA), Sheran Lo conducted a case management pre-licensing follow up inspection and met with Licensee/Applicant Jaqueline Beltran. This is a pending relocation application. Purpose of the inspection was explained to Licensee/Applicant. Present was Licensee/Applicant, Brother, and son.

LPA observed during the inspection all bedrooms on level two were furnished and had personal belongings. Level one is set up with children's furniture for play and napping. Licensee states there are no tenants.

Licensee states living in the home are Licensee/Applicant, brother, and son. Currently enrolled are 10 children with AM and PM schedules. A copy of the roster was obtained. Licensee states sister Mercedes Beltran is the main helper during childcare operation.

Exit interview was conducted with Licensee/applicant Jaqueline Beltran and report was provided.

Licensure pending management review.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Sheran Lo
LICENSING EVALUATOR SIGNATURE: DATE: 11/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/21/2023
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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