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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 210110017
Report Date: 01/08/2024
Date Signed: 01/08/2024 12:43:34 PM

Document Has Been Signed on 01/08/2024 12:43 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:FAIRFAX SAN ANSELMO CHILDREN'S CENTER-SCHOOL AGEFACILITY NUMBER:
210110017
ADMINISTRATOR:TOMSKY, HEIDIFACILITY TYPE:
840
ADDRESS:199 PORTEOUS AVENUETELEPHONE:
(415) 454-1811
CITY:FAIRFAXSTATE: CAZIP CODE:
94930
CAPACITY: 65TOTAL ENROLLED CHILDREN: 65CENSUS: 35DATE:
01/08/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:05 PM
MET WITH:Heidi TomskyTIME COMPLETED:
01:00 PM
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On January 8, 2024, Licensing Program Analyst (LPA) Garcia conducted an unannounced case management visit. Purpose of the inspection was to hand deliver the appeal decision correspondence letter of the facility and the Letter of Deficiency Citation Clearance. LPA met with Director, Heidi Tomsky and explained the purpose of the inspection. Present in the facility are Director with 35 children and 7 teachers.

Appeal request to dismiss the deficiency was submitted. Upon review of the appeal request, the citation was dismissed.
LPA also received images provided by the facility on November 8, 2023, of the corrected physical plant deficiency.

LPA obtained a signed copy of the amended report from the Director.

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 conducted and report was reviewed with the Director, Heidi Tomsky.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Nathan Garcia
LICENSING EVALUATOR SIGNATURE: DATE: 01/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/08/2024
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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