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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380504406
Report Date: 05/28/2019
Date Signed: 05/28/2019 03:35:58 PM

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:SFUSD-SAN MIGUEL EARLY EDUCATION SCHOOL (PS)FACILITY NUMBER:
380504406
ADMINISTRATOR:ELI HORNFACILITY TYPE:
850
ADDRESS:300 SENECA AVENUETELEPHONE:
(415) 469-4756
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94112
CAPACITY:102CENSUS: 78DATE:
05/28/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Aurora HernandezTIME COMPLETED:
03:00 PM
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Licensing Program Analyst, LPA Yee conducted a case management today. Present at the facility are 12 staff members and 78 children. This is a self-reported incident occurred on 4/2/2019. Staff saw a paraprofessional snatched the child's blanket from the child when the child was waking up from the nap, causing the child to cry. The paraprofessional behavior was inappropriate. The staff said this is not the first time this paraprofessional acted out this way. The last two times, teacher intervene before the paraprofessional had a chance. This incident was reported to the site director and the HR department. The paraprofessional is no longer with the facility.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2019
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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