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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410517924
Report Date: 10/03/2024
Date Signed: 10/03/2024 03:53:33 PM

Document Has Been Signed on 10/03/2024 03:53 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:PENINSULA COVENANT CHURCH AFTERCAREFACILITY NUMBER:
410517924
ADMINISTRATOR/
DIRECTOR:		CARRION, MEGANFACILITY TYPE:
840
ADDRESS:3560 FARM HILL BLVD.TELEPHONE:
(650) 365-8094
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94061
CAPACITY: 140TOTAL ENROLLED CHILDREN: 140CENSUS: DATE:
10/03/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:10 PM
MET WITH:Jennifer SturkenTIME VISIT/
INSPECTION COMPLETED:
04:05 PM
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 October 3, 2024, at approximately 3:10 pm, Licensing Program Analyst (LPA) Maria Olguin-Leon conducted an unannounced Case Management inspection. Purpose of the inspection was to hand deliver the appeal decision correspondence letter to the facility. LPA met with Coordinator Jennifer Sturken and explained the purpose of the inspection. Present in the facility office was coordinator. Per coordinator, there are 5 staff and 47 children present at the facility today. All adults working in the facility have criminal background clearances. Facility is currently operating within teacher to child ratio on this date.

LPA hand delivered the amended report dated May 14, 2024, and obtained a signed copy of amended report from coordinator.

Report and Notice of Site Visit is provided.

Notice of Site Visit shall be posted for 30 consecutive days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview was conducted and report was reviewed with Coordinator Jennifer Sturken.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE: DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/03/2024
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