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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001634
Report Date: 10/10/2019
Date Signed: 10/10/2019 12:59:10 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 - VALENCIA GARDENSFACILITY NUMBER:
384001634
ADMINISTRATOR:THERESA SANCHEZFACILITY TYPE:
850
ADDRESS:380 VALENCIA STREETTELEPHONE:
(415) 552-0169
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94103
CAPACITY:36CENSUS: 20DATE:
10/10/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Director, Melva BosleyTIME COMPLETED:
01:20 PM
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Licensing Program Analyst (LPA) Luis J. Gomez met with director Melva Bosley. Purpose of the inspection was explained and is for a case management inspection, to deliver the amended the 809 report done on September 20, 2019. Present is the Director and 6 personnel supervising 30 children. LPA Gomez toured facility with director and inspected for health and safety hazards.

During today's inspection, LPA Gomez observed director sign amended 809, Plan of correction report, from inspection done on 9/20/2019. Copy of the amended report was provided to director.

>No deficiencies were issued today under Title 22 Division 12 of the Ca. Code of Regulations.

> 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: Alma MaligTELEPHONE: (650) 266-8832
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 393-9134
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2019
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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