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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001634
Report Date: 03/11/2024
Date Signed: 03/11/2024 09:59:20 AM

Document Has Been Signed on 03/11/2024 09:59 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:MISSION HEAD START - VALENCIA GARDENSFACILITY NUMBER:
384001634
ADMINISTRATOR:CHRISTINA SAMUELFACILITY TYPE:
850
ADDRESS:380 VALENCIA STREETTELEPHONE:
(415) 552-0169
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94103
CAPACITY: 36TOTAL ENROLLED CHILDREN: 30CENSUS: 16DATE:
03/11/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:13 AM
MET WITH:Christina SamuelTIME COMPLETED:
10:10 AM
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On March 11, 2024, at approximately 8.45am, Licensing Program Analyst (LPA) Tso conducted an unannounced case management visit for the play yard renovation project and met with the Director, Christina Samuel. Present during the inspection was the Director, 8 teachers, caring for 16 children.

LPA observed that the outdoor playground area has not yet started renovation. Per the Director, the Children are playing at the existing outdoor play yard until the renovation of the outdoor play yard works starts. The Director schedules to start renovation in early May 2024, and target to be completed in early June 2024. During the outdoor play yard renovation works, the Director would arrange the children to play at the Dolores Park. The Director stated that the written consents by the parents to take their children to play outside have been got.

Director agrees to submit the new sketch of the outdoor play yard to the Licensing Office on or before March 15, 2024.

Notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Director, Christina Samuel.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Man Tso
LICENSING EVALUATOR SIGNATURE: DATE: 03/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/11/2024
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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