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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002856
Report Date: 12/10/2024
Date Signed: 12/10/2024 04:23:28 PM

Document Has Been Signed on 12/10/2024 04:23 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:CSSF REC DEPT - BURI BURI AFTER SCHOOL PROG. (SA)FACILITY NUMBER:
414002856
ADMINISTRATOR/
DIRECTOR:		KERRY WESTFACILITY TYPE:
840
ADDRESS:325 DEL MONTE AVETELEPHONE:
(650) 875-6900
CITY:SOUTH SAN FRANCISCOSTATE: CAZIP CODE:
94080
CAPACITY: 180TOTAL ENROLLED CHILDREN: 158CENSUS: 105DATE:
12/10/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:25 PM
MET WITH:Kerry West and Kimberly MorrisonTIME VISIT/
INSPECTION COMPLETED:
04:50 PM
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On December 10, 2024 at approximately 2:25pm, Licensing Program Analyst (LPAs) Alvarado and Quimbo conducted an unannounced, case management inspection. LPAs met with Facility Director, Kerry West, and explained the purpose of the visit. During LPAs’ walkthrough, Recreation and Community Services Supervisor Kimberly Morrison arrived, and explained the purpose of the inspection.

Present during inspection included 105 enrolled children (school age) and 12 staff members. Program operates on Buri-Buri Elementary school of South San Francisco school district. Program operates out of Portable classroom #1, Exploratorium, and Multi-purpose room.

Licensee requested to add Room D-112 8/15/2024. Facility obtained a fire clearance 8/22/2024. Facility is currently licensed for 180 school age children. Licensee requested to add Room D-112 as part of overall licensed capacity to 180 school age children.

The school age program is exempt from requirements for indoor and outdoor space square footage, fencing, and toilet/sink ratios. No measurements were taken during the inspection.

The afterschool program operates Monday through Friday in a morning and after school session. Morning session operates from 7:30am to school district bell schedule. After school session operates from school district bell schedule to 6:00pm.

With Facility Director and Supervisor, LPAs inspected the facility, indoors and outdoors, for health and safety hazards. Water is accessible to enrolled children with multiple, accessible water fountains and children's individual water bottles that can be refilled on site.
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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Diana Alvarado
LICENSING EVALUATOR SIGNATURE: DATE: 12/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/10/2024
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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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: CSSF REC DEPT - BURI BURI AFTER SCHOOL PROG. (SA)
FACILITY NUMBER: 414002856
VISIT DATE: 12/10/2024
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LPA observed classroom to be added, clean, equipped with age-appropriate toys, materials and furniture. Room D-112 is equipped with school district fire alarm system and Carbon Monoxide. LPAs tested carbon monoxide detector during visit, which was observed to be working. Per supervisor, the D-112 is currently used by the school district during school district hours as a storage area.

Program is licensed to use restroom located in the multi-purpose area Restrooms allow for individual privacy. LPAs observed restrooms to be clean and in proper condition.

The entire outdoor area of the school is enclosed by a fence that is at least four feet tall. Outdoor area includes one playground, basketball courts and soccer field. Separate after school program also operates on elementary school site that is separate from Recreation and Community Services.

Program is currently the soccer field, playground #1, basketball courts and black tops. Supervisors are aware enrolled children using the playgrounds will always be supervised and monitored. LPA did not observe any pools, spas or bodies of water on school district site. Supervisors are aware children from separate after school programs are not to co-mingle with children enrolled in Recreation and Community Services.

Supervisor was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Prior to approval of Room D-112, the following documents need to be updated and submitted to department:
-LIC 200A Application
-LIC 308 Designation of Facility Responsibility
-LIC 309 Administrative Organization
- Control of Property
- Admission Agreement
- Parent Handbook
-Job Descriptions
- Superintendent Certification

No deficiencies were issued under CCR, Title 22, Division 12.

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 conducted and report was reviewed with Recreation and Community Services Supervisor, Kimberly Morrison.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Diana Alvarado
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2024
LIC809 (FAS) - (06/04)
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