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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002608
Report Date: 07/16/2019
Date Signed: 07/16/2019 01:36:45 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:CARINO, ELLEN-GRACE & CEPHASFACILITY NUMBER:
384002608
ADMINISTRATOR:CARINO, ELLEN-GRACE&CEPHASFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 267-0853
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94112
CAPACITY:14CENSUS: 12DATE:
07/16/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Cepas CarinoTIME COMPLETED:
02:00 PM
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Licensing Program Analyst, LPA conducted a follow-up inspection today. The purpose of today inspection is to clear the deficiency cited on 6/21/2019. The following citations have been corrected today.

1) Required staffs immunization are on file
2) A copy of the roster was obtained today
3) Child Abuse Mandated Reporter Training certificate is on file for all staff members.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2019
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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