<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004876
Report Date: 09/17/2024
Date Signed: 09/17/2024 09:45:52 AM

Document Has Been Signed on 09/17/2024 09:45 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:GARCIA GUZMAN, MARIAFACILITY NUMBER:
384004876
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
09/17/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:50 AM
MET WITH:Maria Garcia GuzmanTIME VISIT/
INSPECTION COMPLETED:
10:00 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 9/17/2024 at 8:50AM., Licensing Program Analysts (LPA), Luis Gomez met with Licensee, Maria Garcia Guzman. The purpose of the visit was explained and was for an Unannounced, Case Management to add backyard to on-limit areas. Present was the licensee and assistant caring for 6 children. (3 infant-age, 3 preschool-age). The adults present have criminal record clearances on file. Per licensee, the days and hours of operations are: Monday- Friday 8:00AM.- 5:00 PM. LPA inspected facility for health and safety hazards.

At 9:00AM., LPA inspected the backyard area. Area was completely enclosed with tall fencing. Outside playthings inspected were in good repair, and the ground surfaces have turf padding installed. Sandbox was covered, and free of foreign objects or hazards. Play structure and slide have been anchored. Home does not have any pools, jacuzzi, fishponds, or bodies of water.

Prior to adding backyard to the on-limit area, licensee will complete the following:


Submit an updated LIC999, Facility Sketch

**No deficiencies were cited against the facility today under CCR, Title 22, Div. 12, Chapter. 3**

Report was reviewed and copy was issued to Licensee, Maria Garcia Guzman. This report will be kept in the facility file and made available for public review upon request.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 09/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/17/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1