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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001634
Report Date: 09/20/2019
Date Signed: 10/10/2019 12:55:49 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: 32DATE:
09/20/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Director, Melva BosleyTIME COMPLETED:
11:05 AM
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THIS IS AN AMENDED REPORT TO CHANGE THE 1ST AND 2ND PARAGRAPHS.
Licensing Program Analyst (LPA), Luis J. Gomez met with Director Melva Bosley for this plan of correction inspection established on 8/22/2019. Present today is the director and 7 staff supervising 23 children; all children present are preschool age. Facility is within capacity limit for the license. LPA Gomez toured the facility with director and inspected for health and safety hazards. The following deficiency from the previously inspection was checked today:

-101229.1 Sign In Sign Out.

Director, Melva Bosley submitted documents to licensing on September 5, 2019. Deficiency issued on 8/22/2019 have been cleared. 'Cleared POC Letter' was given to Licensee.

**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 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: 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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