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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005550
Report Date: 10/23/2024
Date Signed: 10/23/2024 10:43:55 AM

Document Has Been Signed on 10/23/2024 10:43 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:C.A.M. (CFS) DE COLORES (PS)FACILITY NUMBER:
214005550
ADMINISTRATOR/
DIRECTOR:		LOMBARDI, KELSEYFACILITY TYPE:
850
ADDRESS:1123 COURT STREETTELEPHONE:
(415) 526-7500
CITY:SAN RAFAELSTATE: CAZIP CODE:
94901
CAPACITY: 33TOTAL ENROLLED CHILDREN: 16CENSUS: 13DATE:
10/23/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:23 AM
MET WITH:Jenna HerzogTIME VISIT/
INSPECTION COMPLETED:
10:55 AM
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On 10/23/2024, Licensing Program Analyst (LPA) Hanson Leong conducted an unannounced case management visit and met with the Director, Jenna Herzog. The visit was to follow up on an incident that occurred on 10/4/2024. LPA explained the purpose of the visit to the director.

Thirteen pre-k children and nine staff members were present during the visit.

During the visit, the director informed the LPA that a staff member was allegedly involved in an incident with a child and was transferred to another Community Action Marin facility. The director stated that the Human Resources Department conducted an internal investigation against the staff member and found the allegation unfounded.

The department will close out the incident as of 10/23/2024.

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

Today’s report was reviewed with the Director, Jenna Herzog.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE: DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/23/2024
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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