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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384000731
Report Date: 12/20/2019
Date Signed: 12/20/2019 04:16:30 PM

COMPREHENSIVE INSPECTION
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 HEAD START-101 VALENCIA HEAD STARTFACILITY NUMBER:
384000731
ADMINISTRATOR:ELENOR CABRERAFACILITY TYPE:
850
ADDRESS:1330 STEVENSONTELEPHONE:
(415) 252-7008
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94103
CAPACITY:20CENSUS: DATE:
12/20/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Rosario MachaTIME COMPLETED:
04:30 PM
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On date 12/20/19 at approximately 2:10, Licensing Program Analyst (LPA) April Cowan conducted an unannounced Annual Inspection and met with Center's Master Teacher. LPA disclosed the purpose of the inspection and was granted entry into the facility by center Director. There were no staff or children present. School was dismissed early this day because of their Christmas Program. The facility consists of 1 classroom, a kitchen, 2 bathrooms (one if for adults), and an outdoor play area. The classroom has heating and ventilation for safety and comfort.
At 2:30, LPA observed that master teacher's name was not on the facility's list for finger print clearance. Per master teacher, all paperwork for a new director was submitted on August 7, 2019.
LPA and Director conducted an indoor and outdoor inspection of the facility. LPA observed the classroom was clean and orderly with ample age appropriate toys. Director stated the toys are sanitized daily as required.

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SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April CowanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2019
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: MISSION HEAD START-101 VALENCIA HEAD START
FACILITY NUMBER: 384000731
VISIT DATE: 12/20/2019
NARRATIVE
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LPA observed cubbies for each child labeled and orderly. Classroom is used for napping. LPA observed ample cots for licensed capacity as well as individual bed linens. Per master teacher, cots are bedding are cleaned weekly by staff. Bathroom observed were clean and in working order.
A weekly menu was posted on the parents board. The kitchen was observed clean and orderly with plenty of individually stored fruits and vegetables, food and milk that comply with nutritious value per regulations. The Center was observed with two fully charged 2A10BC fire extinguishers. There is a medication cabinet that is locked with key. The outdoor play area observed with a securely anchored play structure and observed with cushioned material underneath to absorb a fall. Facility has working smoke and carbon detectors.
LPA reviewed 2 Staff and 5 children's files. Files were complete with all required documents.
Licensee submitted updated LIC 308, LIC 500, LIC 610, Children's Roster, and IMS Policy.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April CowanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: MISSION HEAD START-101 VALENCIA HEAD START
FACILITY NUMBER: 384000731
VISIT DATE: 12/20/2019
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>No deficiencies were issued today under Title 22 Division 12 of the Ca. Code of Regulations.
An exit interview was conducted. A copy of this report and appeal rights were discussed and left with master teacher whose signature on this form confirms receipt of these documents.

>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 was observed being posted. Licensee was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.cdss.ca.gov

SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April CowanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3