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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004575
Report Date: 03/08/2024
Date Signed: 03/08/2024 02:44:22 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 03/08/2024 02:44 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:ESPINOZA, YADIRAFACILITY NUMBER:
414004575
ADMINISTRATOR:ESPINOZA, YADIRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 315-4277
CITY:SAN MATEOSTATE: CAZIP CODE:
94403
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
03/08/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
12:57 PM
MET WITH:Yadira EspinozaTIME COMPLETED:
03:00 PM
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On March 8th, 2024, at approximately 1:00 PM, Licensing Program Analyst (LPA) Janet Gil attempted to conduct an unannounced annual inspection. Assistant Ester Bautista opened the door for LPA, and let LPA know she would contact her. Licensee arrived and let LPA know she does not feel well. LPA advised licensee to not operate facility if she does not feel well. LPA completed a quick walk through of facility to account for all children in care.

Present during LPA's visit included 2 infants and 5 preschool aged children. Licensee provided names for all children in care to LPA. Licensee is a large license. LPA Gil confirmed both the assistant and licensee present in the home were finger print cleared. LPA let licensee know she would be back to conduct annual inspection soon. LPA provided her contact information for licensee.

Report was written and printed outside of the home, and signed by assistant Ester Bautista.

Report was not signed by licensee due to health concerns.

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Janet Gil
LICENSING EVALUATOR SIGNATURE: DATE: 03/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/08/2024
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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