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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 213001939
Report Date: 09/06/2023
Date Signed: 09/06/2023 12:15:06 PM

Document Has Been Signed on 09/06/2023 12:15 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) HAMILTON (PS)FACILITY NUMBER:
213001939
ADMINISTRATOR:LOMBARDI KELSEYFACILITY TYPE:
850
ADDRESS:5520 NAVE DRIVETELEPHONE:
(415) 883-3791
CITY:NOVATOSTATE: CAZIP CODE:
94949
CAPACITY: 80TOTAL ENROLLED CHILDREN: 80CENSUS: 39DATE:
09/06/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:23 AM
MET WITH:ALIDA LEONTIME COMPLETED:
12:30 PM
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On September 6 2023, Licensing Program Analyst (LPA) Garcia made an unannounced case management visit to the child day care facility listed above and met with Site Supervisor, Alida Leon. Purpose of the visit was explained to the director. The case management visit is from a self reported incident that occurred on 8/23/2023. The facility had 39 children and 9 teachers in total on site.

The day of the incident, August 23, 2023, the student shared with her mother that teacher Silvia from room 4 allegedly did not give her cheese stick when she wanted it during snack time. The child also shared that she was hit on the face by the same staff member. The following day, the mother talked to the family advocate regarding what her child reported about teacher Silvia. The family advocate then reported it to the site supervisor, Alida Leon. Alida immediately talked to Silvia and other staff members of room 4 about the incident. Silvia told the story to Alida that she told the child "I'm not giving you cheese stick because your tummy will hurt, I will give you more bananas." Another teacher, Sara Straw shares with the Site Supervisor that Silvia only offered more bananas due to a doctors note indicating that the child is not allowed to have dairy. Another teacher, Diana Esquivel also shared with the Site Supervisor that teacher Silvia offered more food to whoever wanted more and Teacher Silvia offered the child more fruits and water and communicated with the child that doctor told mom that she should not eat any dairy products.

LPA Garcia interviewed the staff members from room 4 and the child regarding the incident. LPA also obtained the note that was given by the mother regarding lactose sensitivity. Site Supervisor, Alida Leon was also present during the incident and shared such allegations did not happen. Based on the interviews and documents obtained and conducted by LPA, children's personal rights were not violated.

No deficiencies were cited today under Title 22 Division 12 of the California Code of Regulations.

A copy of this report was given to the Licensee and a site visit notification must be posted for 30 days.
Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview was conducted and report was reviewed with Site Supervisor, Alida Leon.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Nathan Garcia
LICENSING EVALUATOR SIGNATURE: DATE: 09/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/06/2023
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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