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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
380505442
Report Date:
09/29/2021
Date Signed:
09/29/2021 12:20:52 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:
NG, JEANNE - JEANNE FAMILY DAY CARE
FACILITY NUMBER:
380505442
ADMINISTRATOR:
NG, JEANNE
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(415) 586-6871
CITY:
SAN FRANCISCO
STATE:
CA
ZIP CODE:
94112
CAPACITY:
12
CENSUS:
10
DATE:
09/29/2021
TYPE OF VISIT:
Case Management - Licensee Initiated
UNANNOUNCED
TIME BEGAN:
11:15 AM
MET WITH:
Queenie Lee
TIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Yee conducted a case management inspection today. Present at the facility are 2 helpers and 10 children. Licensee Jeanne Ng has requested to add Queenie Lee to the license as a co-licensee. All required documents are on file. Queenie Lee's residency was verified today.
No deficiency was cited today.
SUPERVISOR'S NAME:
Ali Zebila
TELEPHONE:
(650) 266-8800
LICENSING EVALUATOR NAME:
Jennifer Yee
TELEPHONE:
(650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE:
09/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/29/2021
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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