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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004808
Report Date: 02/05/2024
Date Signed: 02/05/2024 02:57:04 PM

Document Has Been Signed on 02/05/2024 02:57 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:MARTINEZ SEGOVIA, ANDRESFACILITY NUMBER:
384004808
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
02/05/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Andres MartinezTIME COMPLETED:
03:00 PM
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On 2/5/2024, 2:00PM., Licensing Program Manager (LPM), Marie Rodriguez and Licensing Program Analyst (LPA), Luis Gomez, met with licensee, Andres Martinez. LPA, Gomez provided bilingual Spanish Translation. The purpose of meeting was explained and was an informal/ office meeting, regarding licensee application pending application for change of location, received by the Department. On 11/9/2023, licensee has applied to move his family childcare home, from 71 Hillcrest, Daly City, CA 94014 to 2751 Harrision Street, San Francisco, CA 94110.

License stated regarding the change of address, he chose this location because he had been looking for two years and found only one place that accepted his application. Licensee stated he did not choose the address because of its proximity to his the family child care of his ex-wife/ licensee.

Licensee started his former address is now occupied by several renters and son.
Licensee stated he plans to occupy his new address alone, with his adult son.
Licensee stated regarding lease agreement, the copy he submitted to the department was provided to him, and that he did not make any edits or alterations.

The licensee was advised that the operating requirements for family childcare home requires him to be present 80 percent of the operation hours. Licensee was reminded of the requirements for criminal record clearance adults occupants and assistants prior to presence in a Family Child Care Home.

On 2/5/2024, Licensee will be recommended for approval for change of location.

Report was read and reviewed by all parties. Copy was provided to licensee.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 02/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/05/2024
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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