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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380506508
Report Date: 07/09/2019
Date Signed: 07/09/2019 02:58:36 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:HELEN HAWK CHILDREN'S CENTER - PRESCHOOLFACILITY NUMBER:
380506508
ADMINISTRATOR:PERLA, ELIZABETHFACILITY TYPE:
850
ADDRESS:111 PAGE STREETTELEPHONE:
(415) 863-0681
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94102
CAPACITY:9CENSUS: 4DATE:
07/09/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Elizabeth PerlaTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Van met with Childcare Coordinator, Elizabeth Perla for an unannounced case management inspection. The purpose of this inspection was to discuss a self reported incident that occurred on June 17, 2019. Present there is 1 staff and 4 children.

On the day mentioned above, during nap time the teacher was supervising infants and preschool children in a classroom. While the teacher was attending infants’ side, she heard a commotion on the preschoolers’ side. She went over to the preschoolers’ side and saw C1 exposed himself inappropriately toward another child. In today’s inspection, LPA interviewed the teacher that observed the incident and based on the information obtained and the evidence at the time of the inspection. LPA advised the director that there needs to be a staff for each program. Infants and Pre-school are two separate programs and the ratios are different. Director stated the facility has increased supervision with the children involved and reviewed supervision expectations with all staff as a precaution

Notice of site visit posted and shall remain posted for 30 days.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon VanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2019
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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