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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004260
Report Date: 03/09/2023
Date Signed: 03/09/2023 03:03:34 PM

Document Has Been Signed on 03/09/2023 03:03 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:EDISON MONTESSORI SCHOOLFACILITY NUMBER:
414004260
ADMINISTRATOR:ANGELA TANGFACILITY TYPE:
850
ADDRESS:303 TWIN DOLPHIN DRIVE, # 104TELEPHONE:
(650) 593-6824
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94065
CAPACITY: 45TOTAL ENROLLED CHILDREN: 45CENSUS: 30DATE:
03/09/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Angela TangTIME COMPLETED:
03:15 PM
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On 3/9/2023 at 1:35PM., Licensing Program Analyst (LPA) Luis J. Gomez met with Director, Angela Tang. Purpose of the inspection was explained and was for an unannounced, Plan of Correction inspection. Present was the director and three staff supervising and 30 children. All children have been properly signed in. LPA inspected facility for health and safety hazards.

During today’s inspection, LPA performed site observations, records review and interviewed director.

At 1:40PM, LPA observed the following: Dust and debris build-up from behind dryer has been removed. Director stated she will check behind dryer weekly, removing build-up as necessary.

At 2:00PM., LPA reviewed the facility records. Staff member S1, has received proper fingerprint clearance and association. LPA reminded director to submit background transfer request for new staff (LIC9108) prior to presence with day-care children.

Notice of Site Visit (LIC9213) was observed visibly posted in lobby.
LPA reminded director to have each family sign the, ‘Notice of A-type deficiency’ (LIC9224).

Deficiencies issued on 2/17/2023, has been cleared and ‘Cleared Plan of Correction Letter’ was provided.

Based on today's inspection, no deficiencies were observed in the areas evaluated according to the Title 22 Division 12 Ca. Code of Regulations. Exit interview and report discussed with Director, Angela Tang and signature of this form acknowledges receipt of these documents.

This report must be available in the facility for public review. Notice was provided and must remain posted for 30 days. Licensee was advised for additional questions to call CCL Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 03/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/09/2023
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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