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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004603
Report Date: 09/10/2024
Date Signed: 09/10/2024 02:03:23 PM

Document Has Been Signed on 09/10/2024 02:03 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:LITTLE ROBLES IN THE SUNSETFACILITY NUMBER:
384004603
ADMINISTRATOR/
DIRECTOR:		QUINONEZ, KIMBERLYFACILITY TYPE:
850
ADDRESS:1319 20TH AVENUETELEPHONE:
(415) 508-7313
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94122
CAPACITY: 45TOTAL ENROLLED CHILDREN: 42CENSUS: 38DATE:
09/10/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Kristina GonzalezTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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On September 10, 2024 at approximately 11:00am , Licensing Program Analyst (LPA) Ly conducted an Unannounced Case Management Visit due to an Unusual Incident Report self reported to Licensing on 08/30/2024 by phone call and follow with a written Unusual Incident Report (LIC 624) on 09/03/2024. LPA met with Facility Owner Kristina Gonzalez during the visit. Purpose of the inspection was explained. There were 38 children 11 staff members including the owner present during today's visit. Teacher to child ratios were met on this day.


LPA interviewed the Owner regarding the incident. Facility representative followed Title 22 reporting requirements and have since modified necessary accessories for children to use when leaving the facility to the park.


No deficiencies were issued today under Title 22 Division 12 of the California Code of Regulations. A copy of this report was discussed and left with Facility Owner 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: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/10/2024
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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