410519010-9-1-2026-05-CC-DALO-DXJ2JA-20260901172603

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 410519010
Report Date: 09/01/2026
Date Signed: 09/01/2026 05:26:30 PM

Document Has Been Signed on 09/01/2026 05:26 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:	CSSF REC DEPT-SPRUCE AFTER SCHOOL REC PROGRAM		FACILITY NUMBER:	410519010
ADMINISTRATOR/ DIRECTOR:	THOMAS BOITANO		FACILITY TYPE:	840
ADDRESS:	501 SPRUCE AVENUE, RM. B3		TELEPHONE:	(650) 873-0924
CITY:	SOUTH SAN FRANCISCO	STATE: CA	ZIP CODE:	94080
CAPACITY: 30	TOTAL ENROLLED CHILDREN: 30	CENSUS: 27	DATE:	09/01/2026
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:15 PM
MET WITH:	Facility Representative Recreation Community Supervisor, Kimberly Morrison		TIME VISIT/ INSPECTION COMPLETED:	05:45 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 September 1^st, 2026 at approximately 2:15PM Licensing Program Analyst (LPA) Alvarado arrived to the facility for an unannounced Annual Inspection. LPA met with Facility Director Brittany Burgo(D1), LPA explained the purpose of the inspection. Shortly after Recreation Community Supervisor, Kimberly Morrison(S1) and Child Care assistant supervisor, Francisco Rodriguez(S2) arrived. LPA also explained as well as to discuss an incident that occurred on August 20^th, 2026 and August 21^st, 2026 and was self-reported by the facility on August 27^th, 2026, to the department. Present during today’s inspection is (D1), (S1), (S2) and two staff members present supervising 27 School Age Children. All adults present in the facility have criminal record clearance. Association of staff was discussed with (S1) and (S2). Facility is operating within Ratio and capacity as of today’s inspection. Facility Hours of operation are Monday-Friday 7:30 AM to 8:30 AM (Morning Bell Time), Tk and Kinder Get out at 1:20PM, Older Childre get off at 2:40PM.Facility Closes at 6:00pm LPA inspected the facility Indoors and outdoors along with (S1) today for health and safety hazards. Facility operates in classroom 1, Facility is located and operates on the campus of Spruce Elementary School. LPA observed the classroom to be clean and free from any safety hazards. Furnishings and equipment appear to be safe, in good condition and age appropriate. LPA had the conversation with (S1) in regard to cleaning materials to be placed at a higher level as some children in care are tall or ensuring that it remains locked. The program has use to two bathrooms on site located next to the classroom and located near the playground that is used by facility. Children are supervised when attending the restroom. The classroom is equipped with a first aid kit and emergency supplies. Children bring water bottles from home . Facility provides snack and water if needed. Water sink is located in the classroom. (S1) also stated that matts are provided for those Tk children who want to rest and are given the opportunity to rest. Outdoor space area is in good condition, its enclosed with a fence and push door. There is cushioning underneath the play structure. Continued on Page 2...

Ali Zebila
Diana Alvarado
	DATE: 09/01/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: CSSF REC DEPT-SPRUCE AFTER SCHOOL REC PROGRAM	FACILITY NUMBER: 410519010
	VISIT DATE: 09/01/2026

NARRATIVE

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LPA conducted personnel record review for three staff members, LPA Observed that Mandated Reporter Training is current for Staff Expiring at least 10/2026. Staff are currently enrolled for Pediatric First Aid/CPR training for November 17^th. LPA conducted Children Record Review, a random selection for six children. LPA conducted facility file review and observed proper postings of required forms. LPA reviewed sign in and out logs that are done physical.

Facility will be issued 1 Type B Citation, regarding the incident that occurred on August 20^th, 2026 and August 21^st, 2026 that was also self-reported to the department. Based on Interview with (D1),(S1) and (S2), a Child (C1) left the facility within two days. (S1) confirmed that (C1) left the facility through an opened gate along with two other children who were with the staff member who were trying to reach (C1) on the first incident reported 8/20. On the second day that the incident was also reported, (S1) and (S2) were called for assistance as (C1) managed to take off running past three block. (C1) was safely assisted back to the facility by staff. (C1) parents were notified regarding both incidents and the facility has taken actions regarding physical plant and conversation with staff and (C1) parents. (S1) confirmed that supervision was being maintained on (C1) when (C1) took off running leaving the premises of the facility. Facility will submit an action plan in regard to ensure that an incident like this does not occur again.

Licensee [or facility representative] was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test as specified in Health and Safety Code section 1597.16.

For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP.). LPA verified that the lead testing was completed in accordance to the Written Directives (Interim Licensing Standards) outlined in PIN 21-21.1-CCP.

Continued on Page 3...

NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Diana Alvarado
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/01/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2026

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: CSSF REC DEPT-SPRUCE AFTER SCHOOL REC PROGRAM	FACILITY NUMBER: 410519010
	VISIT DATE: 09/01/2026

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LPA referred licensee [or facility representative] to the Department website for lead: Lead Toxicity Prevention and Water Testing Information (https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information)

• CCC COMPLETED TESTING AND NO LEAD EXCEEDANCES

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22- 02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514- 0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

Licensee [or facility representative] was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

See LIC 809-D for deficiencies being cited today on September 1, 2026 under the California Code of Regulations, Title 22, Division 12, Chapter 1. Regarding Care & Supervision.

See LIC9102-TV for Technical Violation issued today regarding Physical Plant and See LIC 9102-TA techinal assistance.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Facility Representative Recreation Community Supervisor, Kimberly Morrison.

NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Diana Alvarado
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/01/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/01/2026 05:26 PM - It Cannot Be Edited

Created By: Diana Alvarado On 09/01/2026 at 04:59 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: CSSF REC DEPT-SPRUCE AFTER SCHOOL REC PROGRAM	FACILITY NUMBER: 410519010
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/01/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101229(a)

Responsibility For Providing Care and Supervision

(a) The licensee shall provide care and supervision as necessary to meet the children's needs. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on Interview, the licensee did not comply with the section cited above in one child left the facility during two different days, although child was being supervised the child managed to make it down three blocks which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/18/2026
	Plan of Correction
1 2 3 4	Facility will submit to LPA an action plan that will be reviewed with staff, along with signing in how to help prevent any future incidents where child may leave the premise. Although facility also has taken action to ensure that doors are locked, facility will review plan with staff and submit in writing and proper steps that will be taken. Action plan will be sent Via Email to LPA Alvarado by 9/18/2026.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Ali Zebila
NAME OF LICENSING PROGRAM MANAGER:

	Diana Alvarado
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/01/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2026

LIC809 (FAS) - (06/04)

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