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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001977
Report Date: 05/02/2024
Date Signed: 05/02/2024 03:45:06 PM

Document Has Been Signed on 05/02/2024 03:45 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:SANCHEZ, MIRNA D.FACILITY NUMBER:
384001977
ADMINISTRATOR/
DIRECTOR:		SANCHEZ, MIRNA D.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 641-8426
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
05/02/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:15 PM
MET WITH:Mirna SanchezTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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On 5/2/2024 at 3:15PM., Licensing Program Analysts (LPAs) Luis Gomez and Diana Alvarado met with Licensee, Mirna Sanchez. The purpose of the inspection was explained and was for an unannounced, plan of correction inspection established on 4/26/2024. Present was the licensee caring for 5 children (4 preschool-age, 1 infant-age). LPA inspected facility for health and safety hazards.

During inspection, LPA conducted record review, observations, and interviews.

At 3:25PM., LPA’s conducted record of facility records, including the children’s files.
Per licensee, she has collected required forms from the registered families. Signed LIC9227, Individual Sleeping Plan was observed in child’s file, C1.

LPA reminded licensee to remove all items from side of cribs.

Based on today's inspection, no deficiencies were observed in the areas evaluated according to the Title 22 Division 12, Chap 3. Ca. Code of Regulations. Exit Interview was conducted with Licensee, Mirna Sanchez. Licensee’s signature of this form acknowledges receipt of these documents.

This report must be available in the facility for public review. Notice was provided and shall remain posted for 30 days. The licensee was advised for additional questions to call CCL Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 05/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/02/2024
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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