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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001885
Report Date: 01/15/2020
Date Signed: 01/15/2020 04:31:12 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:SFSU - CHILDREN'S CAMPUS (INFANT)FACILITY NUMBER:
384001885
ADMINISTRATOR:TOBIN-WALLIS, ANNAFACILITY TYPE:
830
ADDRESS:N. STATE DR.&LAKE MERCED BLVD.TELEPHONE:
(415) 405-4011
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94132
CAPACITY:36CENSUS: 31DATE:
01/15/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Allison GuerraTIME COMPLETED:
04:45 PM
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Licensing Program Analyst (LPA) Marie Rodriguez made a Case Management visit in conjunction with an Annual Random inspection to discuss the current Site Director of facility. LPA met with Interim Director Allison Guerra and explained purpose of visit. The center is a combination center with an infant/toddler program and a preschool program. Both programs operate under a separate license. SFSU - Children's Campus (Preschool) has license #384001884.

Interim Director stated previous Site Director Anna Tobin-Wallis left the facility in September 2019 and she was hired to be Interim Director during the transition to be the actual Site Director. LPA reviewed which forms and documents were needed to be submitted to CCLD office with Interim Director to update the Site Director designation on the license. LPA provided Interim Director with a director requirement checklist for reference.

Interim Director provided LPA with most of the requirements on the checklist. Once Interim Director has provided LPA with the remaining requested documents, Site Director designation will be updated.

No deficiencies cited today.

This report was reviewed and discussed with Interim Director Allison Guerra. A copy of report was provided.
Notice of site visit was observed being posted and shall remain posted for 30 days.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2020
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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