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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414000469
Report Date: 10/29/2025
Date Signed: 10/29/2025 02:50:16 PM

Document Has Been Signed on 10/29/2025 02:50 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:SSFUSD CHILDREN'S CENTER PRESCHOOLFACILITY NUMBER:
414000469
ADMINISTRATOR/
DIRECTOR:		SHAMSHAD KHALILFACILITY TYPE:
850
ADDRESS:530 TAMARACK LANETELEPHONE:
(650) 827-8400
CITY:SOUTH SAN FRANCISCOSTATE: CAZIP CODE:
94080
CAPACITY: 105TOTAL ENROLLED CHILDREN: 105CENSUS: 46DATE:
10/29/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:20 AM
MET WITH:Child Development Program Coordinator, Eric ClaybonTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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On 10/29/2025, at approximately 9:30AM, Licensing Program Analyst (LPA) Alvarado conducted an unannounced annual visit at the facility. LPA Alvarado met with Child Development Program Coordinator, Eric Claybon (S1). Present during the visit was (S1), Eleven Staff Members supervising 46 preschool-age children. The facility is operating within staffing and ratio requirements on this day.

LPA along with (S1) at approximately 9:30am inspected the facility for any health or safety hazards. The Facility’s licensed classrooms are: Room #1, Room #2, Room #3, Room #4, and Room #6 for Child Care Use, Each classroom has storage for children belonging in assigned and labeled cubbies. Facility also uses the Outdoor Play Area which is fenced in with the school. Facility was reminded that any off-limit areas, must be approved by the department prior to usage. No Pools, hot tubs, spas, or similar bodies of water present in the facility.

Facility Hours of operation are from Monday-Friday 8:00AM-4:00PM. Facility provides meal services that come from the central kitchen, which is through the school district. Facility provides breakfast, lunch and snacks. Classrooms has meal menus posted for parent review. Facility also provided filtered drinking water indoors and outdoors. Facility provided napping equipment for rest time. Per (S1) there are no weapons or firearms in the facility. Facility uses Learning Genie to communicate with parents and verbal communication. Facility also uses another app called Remind 101 as a form of communication. Facility uses physical paper for parents to sign in and out.

Facility classroom were observed to be equipped with fully charged fire extinguishers. Fire alarm systems and Carbon Monoxide Detectors in the classroom. Per (S1) alarms are connected if one goes off. LPA observed Fully equipped Emergency Backpacks that contain First Aid equipment’s. Electrical outlets were observed to be child proof and inaccessible. At approximately 10:00am LPA observed disinfecting wipes and bubble solutions in Room 4, No children were present. (S1) Removed them immediately and made them inaccessible. (S1) was reminded that the facility must ensure to make Poisons, cleaning detergents, and other chemicals inaccessible and out of reach to children in care.

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NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Diana Alvarado
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/29/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: SSFUSD CHILDREN'S CENTER PRESCHOOL
FACILITY NUMBER: 414000469
VISIT DATE: 10/29/2025
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Outdoor play area has sufficient shading and has rubber foam for safe landing zones. LPA observed the outdoor play areas to be free of debris and other loose articles. There are age-appropriate toys and equipment present. The outdoor play area is enclosed by a fence that is at least four feet high.

At 11:30am LPA reviewed 6 staff files, there is at least one staff members present who has current Pediatric First Aid/CPR training that Expires 1/2026. Staff have qualifications and permits to support their qualifications for review. Immunization records were available for review. LPA observe that a few Staff had the completed Mandated Reporter Training, LPA reminded (S1) that every staff member must have the completed mandated reporter training. LPA reviewed 5 children files, that were observed to be complete with required forms. Fire drills have been conducted and documented for review; Last emergency drill was conducted in October 2025. LPA reminded (S1) that Emergency drills must be conducted and logged at least once every six months. All required postings were observed to be posted and accessible for review upon entry to the facility, LPA advised on a few that needed to be posted. Facility also has all required posting for review in each classroom.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at
www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a
maximum of 30 days per person will be assessed if this regulation is violated.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).

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NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Diana Alvarado
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2025
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: SSFUSD CHILDREN'S CENTER PRESCHOOL
FACILITY NUMBER: 414000469
VISIT DATE: 10/29/2025
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Facility tested for Lead on 12/15/2022. Lead Results were posted on the California Water Board Site and Load Date Results were posted on 12/22/2022. Facility is in compliance with lead testing and LPA reminded (S1) that testing will be done again every 5-years after the date of the first test.

For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.


Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Based on today's inspection 10/29/2025, No deficiencies were issued today during LPA's visit.

See LIC 9102-TV for Technical Violation regarding Staff Records.
See LIC9102-TA for Technical Advisory regarding Physical Plant, Staff Records, and children Records.

Appeal rights were provided to (S1). A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit Interview was conducted with Child Development Program Coordinator, Eric Claybon
NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Diana Alvarado
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2025
LIC809 (FAS) - (06/04)
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