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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380500308
Report Date: 01/24/2020
Date Signed: 01/24/2020 11:09:00 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:HOLY FAMILY DAY HOMEFACILITY NUMBER:
380500308
ADMINISTRATOR:MEYERS-THUM, KIMFACILITY TYPE:
850
ADDRESS:299 DOLORES STREETTELEPHONE:
(415) 861-5361
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94103
CAPACITY:150CENSUS: DATE:
01/24/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Setareh PooyanTIME COMPLETED:
11:30 AM
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On January 24, 2020 at 9:50 AM, Licensing Program Analyst (LPA) Cowan met with interim director for a Case Management Inspection - Follow-up for Incident Report. The purpose of the inspection is explained and LPA is granted access to facility. Present in facility is Director, 26 teachers, and 118 students.

Executive Director isn't on site. At 10:00 AM, Executive Director, Heather Morado, called in to speak with LPA. LPA conducted interview with Director Executive. Executive Director states that mother involved is spreading false and accusations about school and teacher. Facility has hired attorneys to investigate and they have contacted their insurance company.

Director submitted attendance information, Communication Notes, and emails regarding parent and child connected to incident.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April CowanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2020
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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