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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001243
Report Date: 11/26/2019
Date Signed: 11/26/2019 04:25:21 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:GOLDFELD, GALINA & GOLDFELD, VLADIMIRFACILITY NUMBER:
384001243
ADMINISTRATOR:GOLDFELD, GALINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 731-5943
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94116
CAPACITY:14CENSUS: 8DATE:
11/26/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
03:05 PM
MET WITH:Galina GoldfeldTIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Van met with licensees, Galina Goldfeld and Vladimir Goldfeld for an unannounced inspection of the Plan of Correction (POC). The purpose of the inspection was explained and was granted entry to the home by the licensees. Present, there are 8 children (6 preschoolers and 2 infants) in care with the licensee along with 2 helpers.

On Nov 13, 2019, annual inspection, the following deficiency was cited. Files review confirmed several children had incomplete parents' rights LIC995A form. In today's inspection, children’s records were reviewed and found that all children have completed parents’ rights from in their file. Deficiency that was cited on Nov 13,2019, is cleared today. Copy of Letter of Deficiency Citations will be sent licensee.

An exit interview was conducted with licensees. Consultation was provided. No deficiencies are cited today. A copy of this report is reviewed and provided to the licensee. Notice of site visit is posted and shall remain posted for next 30 days.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon VanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2019
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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