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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384000066
Report Date: 06/28/2022
Date Signed: 06/28/2022 03:28:00 PM


Document Has Been Signed on 06/28/2022 03:28 PM - It Cannot Be Edited

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-PRESIDIO (EES) INFANT/TODDLERFACILITY NUMBER:
384000066
ADMINISTRATOR:COOK, CAROLYNEFACILITY TYPE:
830
ADDRESS:387 MORAGA AVETELEPHONE:
(415) 561-5822
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94129
CAPACITY:30CENSUS: 8DATE:
06/28/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Carolyne CookTIME COMPLETED:
03:50 PM
NARRATIVE
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Licensing Program Analyst (LPA) Mok conducted an unannounced case management inspection for an unusual incident the facility reported to CCL on 5/2/2022. LPA met with the Site Director, Carolyne Cook. The purpose of the inspection was explained. There were 8 children with 3 staff present. One of the parents reported to the Site Director about the parent saw a staff "dragging" a child across the floor on 4/27/2022. The facility conducted internal investigation on the incident. LPA obtained the relevant documents from the facility during the inspection. Also, the involved staff were no longer working at the facility. According to the documents, the staff did not recall the incident had happened. The staff was helping the child to put the shoes on at the table. The incident was determined unsubstantiated because LPA could not collect sufficient evidence to prove it happened or not.








This report and notice of site visit were discussed with the licensee and must be made available to the public upon request. For quarterly update on Licensing information, go to CCL website: www.ccld.ca.gov. For Provider Information Notice: ccld.ca.gov/PG5098.htm
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy MokTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 06/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/28/2022
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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