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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
414004024
Report Date:
09/14/2023
Date Signed:
09/14/2023 12:56:42 PM
Document Has Been Signed on
09/14/2023 12:56 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:
AQUINO, ANNABELLE
FACILITY NUMBER:
414004024
ADMINISTRATOR:
AQUINO, ANNABELLE
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(650) 734-6514
CITY:
SOUTH SAN FRANCISCO
STATE:
CA
ZIP CODE:
94080
CAPACITY:
14
TOTAL ENROLLED CHILDREN:
14
CENSUS:
4
DATE:
09/14/2023
TYPE OF VISIT:
POC
UNANNOUNCED
TIME BEGAN:
12:25 PM
MET WITH:
Annabelle Aquino
TIME COMPLETED:
01:15 PM
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Licensing Program Analysts (LPAs) Andrea Medlin and Jonathan Tse met with facility representative for this plan of correction visit established on 7/6/2023. The following previously cited deficiency is observed to be corrected and cleared today:
Section
102417 - This requirement is not met as evidenced by: Children's files are incomplete. See LIC 857 - Children's Record Review for a list of what is missing in each child's file. The child's file is observed to be complete.
This report is reviewed with Licensee and a copy of this report must be made available for public review upon request.
Notice of site visit posted and shall remain posted for 30 days.
SUPERVISORS NAME
:
Daniel J Oquendo
LICENSING EVALUATOR NAME
:
Andrea Medlin
LICENSING EVALUATOR SIGNATURE
:
DATE:
09/14/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/14/2023
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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