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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002453
Report Date: 11/01/2022
Date Signed: 11/01/2022 02:57:38 PM


Document Has Been Signed on 11/01/2022 02:57 PM - It Cannot Be Edited

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:SFUSD-ROOFTOP EARLY EDUCATION SCHOOL (PS)FACILITY NUMBER:
384002453
ADMINISTRATOR:BURGOS, JEFFREY T.FACILITY TYPE:
850
ADDRESS:443 BURNETT STREET, ROOM 7TELEPHONE:
(415) 379-2700
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94131
CAPACITY:22CENSUS: 12DATE:
11/01/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:55 PM
MET WITH:Sam Ferber & Darren KawaiiTIME COMPLETED:
03:00 PM
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On November 1, 2022 at approximately 1:55pm, Licensing Program Analyst (LPA), Catrina Quimbo conducted an unannounced, case management visit to SFUSD-Rooftop Early Education School in Preschool Classroom #7, in regards to an unusual incident.

LPA met with lead teacher, Sam Ferber, and explained the purpose of the visit. Present in preschool classroom #7 includes lead teacher, para-educator, and 12 enrolled children. Program is operating within capacity requirements and ratios at time of LPA's visit.

Facility self reported an unusual incident to department October 19, 2022. LPA spoke with lead teacher and school principal regarding incident.

The facility took action to conduct an internal investigation that involved school social worker. Incident was properly reported to appropriate agencies.

Per lead teacher, children are always supervised and checked on by lead teacher and para-educator. LPA observed classroom to include a restroom that includes 1 toilet and 1 sink. Bathroom was observed not to have a door and is within line of vision to main classroom.

No deficiencies were cited today under CCR, Title 22, Div. 12.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with lead teacher, Sam Ferber.
SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina QuimboTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 11/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/01/2022
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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