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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384000867
Report Date: 02/28/2020
Date Signed: 02/28/2020 04:55:31 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 HEAD START-WOMEN'S BUILDING CENTERFACILITY NUMBER:
384000867
ADMINISTRATOR:REYES, CINDYFACILITY TYPE:
850
ADDRESS:3543 18TH STREETTELEPHONE:
(415) 701-1995
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY:23CENSUS: 3DATE:
02/28/2020
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
04:20 PM
MET WITH:Theresa Sanchez- PerezTIME COMPLETED:
05:10 PM
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Licensing Program Analyst, (LPA) Luis J. Gomez met with Regional Manager, Theresa Sanchez- Perez. Purpose of the inspection was explained and is for a plan of correction inspection. Present is director and three staff supervising three children. LPA Gomez inspected the facility with director for health and safety hazards. Reviewed today was the deficiency issued on: 1/28/2020.

On February 13, 2020, Regional Manager submitted agenda and staff roster for the facility-wide training, to the Community Care Licensing Office. Staff training emphasized parent and staff protocol regarding the facilities electronic sign-in and sign-out system procedure.

Deficiency issued on 1/28/2020 have been cleared. 'Cleared POC Letter' was given to site director.

**No deficiencies were cited against the facility today under CCR,Title 22, Div. 12, Chapt. 1**

This report and rights to comment and appeal were discussed with Director. This report must be kept in the facility available for public review. Notice of site visit was observed being posted.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2020
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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