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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005507
Report Date: 08/05/2024
Date Signed: 08/05/2024 11:03:01 AM

Document Has Been Signed on 08/05/2024 11:03 AM - 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:CANALES, EVELYN A.FACILITY NUMBER:
214005507
ADMINISTRATOR/
DIRECTOR:		CANALES, EVELYNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 234-8646
CITY:NOVATOSTATE: CAZIP CODE:
94949
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
08/05/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:24 AM
MET WITH:Evelyn CanalesTIME VISIT/
INSPECTION COMPLETED:
11:20 AM
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On August 5, 2024 at 09:24 AM, Licensing Program Analyst (LPA) Garcia, conducted an unannounced, plan of correction (POC) visit. LPA met with Licensee, Evelyn Canales, and explained the purpose of the visit. Present during LPA visit includes Licensee, husband and 6 children in care (all school age children).

On July 23, 2024, LPA Garcia met with licensee to conduct an unannounced, annual inspection visit. During annual visit, LPA reviewed the and observed that one of the licensee's adult son is not fingerprinted and her mandated reporter certificate is expired. LPA issued a Type A citation for un-fingerprinted adult in the home and Type B deficiency for expired mandated reporter certificate. A POC was developed with licensee.

LPA received an email from licensee on August 1, 2024 attaching a copy of the livescan form and the update mandated reporter certificate. As of today's visit,Type A and Type B deficiency clearance letters were provided to licensee. LPA informed licensee to send the signed Acknowledgement of Receipt of Licensing Reports (LIC 9224) for currently enrolled and future children.

Deficiency cited on July 16, 2024 has been cleared as of this date. LPA provided licensee copies of POC letters. No deficiencies were cited today.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with licensee, Evelyn Canales.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Nathan Garcia
LICENSING EVALUATOR SIGNATURE: DATE: 08/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/05/2024
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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