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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002512
Report Date: 01/14/2020
Date Signed: 01/14/2020 12:24:04 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:WU YEE CHILDREN'S SERVICES-CADILLAC CENTER (PS)FACILITY NUMBER:
384002512
ADMINISTRATOR:SANDHU, PARNEETFACILITY TYPE:
850
ADDRESS:316 LEAVENWORTH STREETTELEPHONE:
(415) 409-3101
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94102
CAPACITY:40CENSUS: 37DATE:
01/14/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Parneet SandhuTIME COMPLETED:
12:30 PM
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License Program Analyst (LPA) Kaur conducted an unannounced case management visit and met with Director Parneet Sandhu. Purpose of inspection was explained. facility self reported the unusual incident that occurred on December 19 2019. Present there are 37 children and 7 teachers.
On the mentioned incident above , a child was sustained an injury on his chin. Resulted from tripping over rocks which are part of facility nature scene. child's mother took child to hospital for further evaluation. As part of todays inspection, LPA interviewed director. Per director Teacher witnessed the incident. LPA conducted an evaluation of physical space where that incident occurred as well as care and supervision being provided by teachers base on interview and relevant information obtained, it was determined it was an accident and the staffing and supervision was appropriate at the time of the child tripped over rock and fell. Director stated that on mentioned date there were 3 teachers and 1 coach was supervising 16 children. The facility was in ratio at the time of incident and there are no deficiency discovered or observed.


No deficiency are being cited today. A Notice Of Site Visit was posted. The Notice is to remain posted for 30 days.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Harsimran KaurTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2020
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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