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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001834
Report Date: 10/24/2019
Date Signed: 10/24/2019 10:22:48 AM

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:SOUTHEAST FAMILIES UNITED/MISSION HEAD STARTFACILITY NUMBER:
384001834
ADMINISTRATOR:EUGENIA JAMESFACILITY TYPE:
850
ADDRESS:1337 EVANS AVENUETELEPHONE:
(415) 920-7000
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94124
CAPACITY:32CENSUS: DATE:
10/24/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Eugenia JamesTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Singh met with director, Eugenia James, for a case management of an incident. Purpose of the inspection was explained. The facility self reported that On September 20, 2019, a teacher had group of children playing in play yard and a child remained in play yard while other children came inside with teacher.

During today’s inspection, LPA interviewed the director. Director stated that on above mentioned day, teacher Vivian Lopez was outside in play yard with eight children. Per director, at about 11 AM, teacher Lopez lined up all of the children to bring them back into the classroom. Per director, teacher counted all eight children and started the transition. Per director, as the children were moving into the classroom, one child ran back into the play yard hide behind ‘cube’ (play structure). Per director, another teacher from infant program was bringing infants to the next play yard and observed the child hiding. Per director, infant teacher brought the child into the preschool classroom, as rest of the group was still next to the door washing the hands at the sink. Per director, when teacher Lopez asked the child about what happened, the children informed that child was hiding from teacher as playing. Per director, teacher Lopez called the father of the child and informed about the incident. Per director, child’s grand mother came to facility at the end of the day to pick up the child and the child was laughing and telling the grand mother about how the child hide in play yard from the teacher. Per director, facility has rearranged the play yard. Per director, there use to be eight cubes and now there are only two, which provides more visible around the play yard.

During the interview, it was found that the child never left the property, the child was outside in play yard without child’s designee teacher for about three to four minutes, the child was supervised by another teacher from infant program and child was brought back into classroom by facility staff. Facility followed the procedures and informed the parent and licensing department.
No deficiencies are cited today. Copy of this report is reviewed and provided to the director. Notice of site visit is posted and shall remain posted for next 30 days.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Gagandeep SinghTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2019
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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