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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001634
Report Date: 09/19/2024
Date Signed: 09/19/2024 11:16:01 AM

Document Has Been Signed on 09/19/2024 11:16 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/
DIRECTOR:		CHRISTINA SAMUELFACILITY TYPE:
850
ADDRESS:380 VALENCIA STREETTELEPHONE:
(415) 552-0169
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94103
CAPACITY: 36TOTAL ENROLLED CHILDREN: 28CENSUS: 24DATE:
09/19/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:36 AM
MET WITH:Christina SamuelTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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C1 = The Child

On September 19, 2024 at approximately 8:40 AM, Licensing Program Analyst (LPA) Tso conducted an unannounced, case management visit. LPA met with Director, Christina Samuel, and explained the purpose of the visit. Present in the facility is director, 8 staff, and 24 children in care.

The case management visit is regarding an unusual incident that occurred on August 22, 2024. Facility self-reported incident to CCLD on August 26, 2024.

On August 22, 2024, the Early Education Director of the facility received an email for the allegation the teachers left a child alone in the park.

After observation at the park, interviewed with the Director, staff and C1, and the incident report, there is no evidence found to prove any lack of supervision violations by the facility.

There were no deficiencies cited at this time under CCR, Title 22, Div. 12, Chapter 3. A copy of today’s report was given to the Director.

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: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/19/2024
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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