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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004588
Report Date: 06/21/2023
Date Signed: 06/21/2023 10:45:39 AM

Document Has Been Signed on 06/21/2023 10:45 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:MISSION MONTESSORI (INF)FACILITY NUMBER:
384004588
ADMINISTRATOR:DOMINGO, ROCHELLEFACILITY TYPE:
830
ADDRESS:50 FELL STREETTELEPHONE:
(415) 805-8315
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94102
CAPACITY: 54TOTAL ENROLLED CHILDREN: 54CENSUS: 39DATE:
06/21/2023
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Rochelle DomingoTIME COMPLETED:
10:46 AM
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On June 21, 2023, Licensing Program Analyst (LPA) Sheran Lo met with Director Rochelle Domingo. Purpose of the inspection was explained and is for a case management inspection to follow up with Pre-Licensing and classroom changes.. Present is the Director and 17 staff supervising 39 children. LPA Lo toured facility with director and inspected for health and safety hazards.

During today's inspection, LPA Lo observed the classroom changes, and discussed that when there are changes, CCLD must me notified.

>No deficiencies were issued today under Title 22 Division 12 of the Ca. Code of Regulations.

Licensure will be approved for 18 infants and 36 children in toddler option, a total of 54 children, when STD 850 is signed by Fire Marshal.

> This report must be available in the facility for public review. Notice of site visit was observed being posted.
Licensee was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.cdss.ca.gov
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Sheran Lo
LICENSING EVALUATOR SIGNATURE: DATE: 06/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/21/2023
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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