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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002726
Report Date: 05/24/2023
Date Signed: 05/24/2023 04:12:38 PM

Document Has Been Signed on 05/24/2023 04:12 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:KAI MING RAINBOW PRESCHOOL CENTERFACILITY NUMBER:
384002726
ADMINISTRATOR:LEI, IOKCHANFACILITY TYPE:
850
ADDRESS:799 PACIFIC AVENUETELEPHONE:
(415) 982-4777
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94133
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: 19DATE:
05/24/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Jiejun Du, Jenny Zhong & Ellen Peterson-AllenTIME COMPLETED:
12:30 PM
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On May 24, 2023, Licensing Program Analyst (LPA) Ly conducted an Unannounced Case Management Visit for a self reported incident occurred on 04/26/2023. LPA met with Toddler Room Lead Teacher Jiejun Du, Family Advocate Jenny Zhong and Regional Manager Ellen Peterson-Allen. Purpose of Visit was explain. Per staff, the 19 preschoolers are a field trip and will not return to facility until approximately 3:00pm.


During today's visit, LPA interview a staff that was mentioned in the report. LPA was not able to interview involve child and other staff mentioned on the report as the class is not on site during the time of visit. LPA also review child's record.


A copy of this report and appeal rights were discussed and left with Regional Manager whose signature on this form confirm receipt of these reports. Notice of Site Visit was posted. Notice to remain posted for 30 days. For updates on Licensing information, go to CCL website: www.ccld.ca.gov. For Provider Information Notice: ccld.ca.gov/PG5098.htm
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Winnie Ly
LICENSING EVALUATOR SIGNATURE: DATE: 05/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/24/2023
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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