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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004829
Report Date: 03/14/2024
Date Signed: 03/14/2024 02:10:24 PM

Document Has Been Signed on 03/14/2024 02:10 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:ZAMORA GOMEZ, SANDRAFACILITY NUMBER:
384004829
ADMINISTRATOR:ZAMORA GOMEZ, SANDRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 756-6533
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94112
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
03/14/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Sandra Zamora GomezTIME COMPLETED:
02:20 PM
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Licensing Program Analyst, LPA Yee conducted a case management visit today. Present at the facility are licensee, Sandra, her helper and 5 children. Sandra requested to add the backyard. The backyard was inspected by the fire marshall. Sansra said she will use the backyard for art and gardening project only. LPA took pictures and will discuss with CCL management team.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jennifer Yee
LICENSING EVALUATOR SIGNATURE: DATE: 03/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/14/2024
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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