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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414005025
Report Date: 08/27/2024
Date Signed: 08/27/2024 03:55:27 PM

Document Has Been Signed on 08/27/2024 03:55 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:MERIDA, HEALYN A.FACILITY NUMBER:
414005025
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
08/27/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:15 PM
MET WITH:Licensee, Healyn MeridaTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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On August 27, 2024, at approximately 3:15pm, Licensing Program Analyst (LPA) Melissa Zaragoza conducted an unannounced, plan of correction (POC) visit. LPA met with licensee,Healyn A. Merida, and explained the purpose of the visit. Present during today's visit included licensee and her assistant.

On August 20, 2024, at approximately 9:15am, LPA Zaragoza conducted an unannounced, annual inspection. During annual inspection, licensee was issued one Type A citation for operating over licensed capacity limits, operating with 4 infants, 2 preschool age children, and 1 school age child. A POC was discussed with licensee.

As of this date, LPA observed licensee to be operating with 6 children (3 infants, and 3 preschool age children). During visit, LPA also observed children’s records and checked for LIC 9224 form to be In the children’s files. LIC 9224 form from the Type A citation was signed by each parent and filed in each children’s record. All children’s record are complete and have all required forms on file. LPA also observed an updated Child Care Facility Roaster that is actualized with the children that left and the children that remain under care. LPA also observed Notice of Site Visit to be properly posted and available for review.

LPA confirmed licensee to be operating within licensed capacity limits on this date.

Deficiencies cited on August 20, 2024, have been cleared during today's visit. LPA provided licensee with POC letters. No deficiencies were cited today.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with licensee, Healyn A. Merida.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE: DATE: 08/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/27/2024
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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