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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 03:35:16 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:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Aurora HernandezTIME COMPLETED:
02:30 PM
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2, Licensing Program Analyst, LPA Yee conducted an annual random inspection today. LPA met with staff in charge, Aurora Hernandez for this inspection. Today, there are 78 children and 12 staff members present at the facility. The facility operates from Monday - Friday, 7:45 am - 5:45 pm. Preschool classrooms: room # 14, 15, 16, 18, 19. Required immunization for staff are on file. LPA discussed the Mandated Reporter Training, AB1207 that was effective on 1/1/2018. All staff must take the training and keep the certificate on file. The training needs to be renewed once every 2 years. Child Abuse Mandated Reporter Training, AB1207. https://www.mandatedreporterca.com/
All staff has AB1207 certificate on file. A written Incidental Medical Services plan is on file. The staff has current CPR & 1st aid certificate until 9/2020. The facility is equipped with a fire extinguisher, smoke detector, and carbon monoxide detector which meets fire department standard. The facility is adequately furnished with age-appropriate toys, furniture, and equipment. Outdoor play areas are adjacent to all the classrooms and securely fenced. Playground equipment is in good condition. Drinking water is readily available for both indoors and outdoors. The facility provides snacks and lunches. First Aid supplies are available in every classroom. Last emergency drills was conducted on 1/28/2019. A log sheet was reviewed during the inspection.

Forms and website: www.ccld.ca.gov. Title 22, Div 12, Chp 1.
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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