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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004621
Report Date: 03/30/2023
Date Signed: 03/30/2023 11:02:51 AM

Document Has Been Signed on 03/30/2023 11:02 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:ZULHENDRI, FELICIA AND SIMAN, SUDHARMONOFACILITY NUMBER:
384004621
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
03/30/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:02 AM
MET WITH:Felicia and Siman ZulhendriTIME COMPLETED:
11:18 AM
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On March 30, 2023, Licensing Program Analyst (LPA) Sheran Lo met with applicants Felicia Zulhendri and Sudharmono Siman for a scheduled Case Management Inspection to Increase Capacity for a Large Family Child Care Home. The facility will operate Monday-Friday; 8:30 AM to 5:00 PM. The facility was inspected today, indoor and outdoor, for health and safety hazards.

Indoor: Child Care area include Living Room, Dining Room, Bedroom 2, and Bathroom 2. Off Limit: Bedroom 1 and Bathroom 1.

Outdoor: The outdoor area has a rug and cement boundary and locked gate to the public alley.

Fire Clearance has been conducted on February 16, 2023 and approval if received by our office.

LPA Lo will recommend licensure of this facility for a Large Family Child Care Home as of today.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Sheran Lo
LICENSING EVALUATOR SIGNATURE: DATE: 03/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/30/2023
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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