<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380505833
Report Date: 07/08/2020
Date Signed: 07/10/2020 02:40:10 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:MISSION CHILDCARE CONSORTIUM, INC.FACILITY NUMBER:
380505833
ADMINISTRATOR:SANTANA, MELANIEFACILITY TYPE:
850
ADDRESS:4750 MISSION STREETTELEPHONE:
(415) 586-6139
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94112
CAPACITY:224CENSUS: 0DATE:
07/08/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Ivy HomTIME COMPLETED:
04:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
LPA Yee conducted a case management tele-inspection today. I spoke with the program director, Ivy Hom. This is a self-reported incident that occurred on March 10th. A 4 years old child reported to mom that one of the teachers mistreated her. Mom complained to the center. The facility dismissed the teacher from the classroom on the same day. After checking the attendance sheets, the child did attend the school until 3/16. Then, the following week, 3/17 the facility was closed due to shelter in place.

There were a total of three teachers in that classroom. The child was not interviewed. The three teachers were not interviewed. Mom did not bring it up again. The video footage is not available for the LPA review. Then the child came back to school on June 8th. One teacher is back in the classroom and the other two teachers are still out due to not enough enrollment at the facility. LPA obtained contact information. Further investigation is needed.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1