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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 210108890
Report Date: 05/21/2024
Date Signed: 05/21/2024 12:53:38 PM

Document Has Been Signed on 05/21/2024 12:53 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:C.A.M.(CFS)-OLD GALLINAS CHILDREN'S CENTER (PS)FACILITY NUMBER:
210108890
ADMINISTRATOR/
DIRECTOR:		LEYDIS MATAFACILITY TYPE:
850
ADDRESS:251 NORTH SAN PEDRO ROADTELEPHONE:
(415) 472-1663
CITY:SAN RAFAELSTATE: CAZIP CODE:
94903
CAPACITY: 140TOTAL ENROLLED CHILDREN: 115CENSUS: 71DATE:
05/21/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:48 AM
MET WITH:Sheily Rodas MartinezTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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On 5/21/2024, Licensing Program Analyst (LPA) Hanson Leong conducted an unannounced case management visit to the Child Care Center (CCC) listed above. The purpose of the visit was to follow up with a self reported incident involving a child and a staff member. LPA met with the Interim Director, Sheily Rodas Martinez, and explained the purpose of the visit. Seventy-one preschool aged children and twenty-nine staff members were present during the visit. The twenty-nine staff members present at the CCC received criminal record clearance from the department. The CCC operates within its capacity and in accordance with the required ratio of staff to children.

The interim director stated that the staff member who was involved in this incident was on administrative leave pending an internal investigation from their Human Resources (HR) Department. LPA requested the interim director to notify the department once their HR department completes its investigation.

No deficiencies were issued today during LPA's visit.

A copy of today’s report was given to the Interim Director, Sheily Rodas Martinez.

A Notice of Site Visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Interim Director, Sheily Rodas Martinez.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE: DATE: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/21/2024
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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