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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380504560
Report Date: 08/22/2019
Date Signed: 08/22/2019 11:39:35 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:SFUSD-JUNIPERO SERRA EARLY EDUCATION SCHOOL (PS)FACILITY NUMBER:
380504560
ADMINISTRATOR:MANCINA, JANE G.FACILITY TYPE:
850
ADDRESS:155 APPLETON STREETTELEPHONE:
(415) 920-5138
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY:67CENSUS: 43DATE:
08/22/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Vani Ari TIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPAs) Bashir-Tariq and Kaur conducted a case management inspection today in response to an unusual incident report received on August 6, 2019. Present there were 42 children and 11 staff. Facility self-reported the incident. The incident involved C1 getting a mark on his arm while teacher grabbed him.

LPAs Spoke to the Director Vani Ari, Teacher Annie, Teacher Kwaiyan Yungchi and C1. Based on the statements obtained from witnesses, it was not established that if the incident occurred in the classroom at the facility. Management and executive staff responded immediately to the occurrence of this incident and spoke to teacher Annie to discuss policies and procedures for providing care and supervision to children at all times. Staff involved in the incident had a discussion with the principal and the management. Discipline policy for the school is redirection and communication. Principal stated that facility conducted the investigation into the matter internally and did not find any evidence of the occurrence in the facility.

>No deficiencies were cited today under Title 22 Division 12 of the California Code of Regulations.

This report and rights to comment and appeal were discussed with Licensee. This report must be available in the facility for public review. Notice of site visit shall be posted for 30 days from today's visit.
Licensee was advised for any additional questions to call Office, M-F, 8AM-5PM at 650-266-8800 . For Rules and Regulations, visit the Website: www.cdss.ca.gov
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8867
LICENSING EVALUATOR NAME: Farhan Bashir-TariqTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2019
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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