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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002983
Report Date: 12/03/2019
Date Signed: 12/03/2019 03:42:59 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:FRANDELJA FAIRFAXFACILITY NUMBER:
384002983
ADMINISTRATOR:POE, SHELLYFACILITY TYPE:
830
ADDRESS:901 B FAIRFAX AVENUETELEPHONE:
(415) 822-1699
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94124
CAPACITY:21CENSUS: 15DATE:
12/03/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Sandra Young and Cornell CobbinsTIME COMPLETED:
02:00 PM
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Licensing Program Analysts (LPAs) Rodriguez and Gomez met with Program Director Sandra Young and new Site Director Cornell Cobbins for an annual random inspection today. The purpose of the inspection was explained. Present today are 6 infants and 9 toddlers with 7 staff members. Facility is operating within ratio today. Paperwork to establish Cornell Cobbins as the new director will be sent to the licensing office within 30 days.

LPAs inspected the daycare areas for health and safety hazards. Per staff, there are no pools, spas, or other bodies of water at the facility. Facility is equipped with smoke detectors, a carbon monoxide detector, several fully charged fire extinguisher, and a working telephone line. All cleaning solutions, poisons, and other chemicals that are dangerous area made inaccessible. Furniture is age appropriate and in good repair. Facility has sufficient amount of cribs for the infant children. LPAs observed children's changing area clean and free of debris. All toilets, hand washing facilities are in working condition. All storage containers for solid waste have proper tight fitting lids. Drinking water is made available for the children in care. The facility provides all meals. LPAs observed all required postings. Meals are provided by an outside vendor known as Chefables. Food preparation area is kept clean and free of debris. Play yard is free of hazards. All of items for the children to use outside are in good repair. Facility's has a tarp for the sandbox.

See next page for continuation ...............
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Adam RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2019
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: FRANDELJA FAIRFAX
FACILITY NUMBER: 384002983
VISIT DATE: 12/03/2019
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Continuation from previous page ..............

LPA review AB 1207 with the director. As of January 1, 2018 all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. LPA observed the completion certificates for the training of the records checked on this day.

LPAs discussed the effects of lead exposure with the director. LPA encourages the director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. Licensee can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

LPA reviewed a sample of staff and children's files. Staff files have all required forms and documents. Children's files have all required signed assessments and agreements on file.

No deficiencies are cited today. The 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: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Adam RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2019
LIC809 (FAS) - (06/04)
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