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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384003048
Report Date: 02/20/2020
Date Signed: 02/20/2020 12:12:45 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:UNIVERSITY CHILD CARE AT MISSION BAY (INF)FACILITY NUMBER:
384003048
ADMINISTRATOR:THAI, KIMBERLYFACILITY TYPE:
830
ADDRESS:727 NELSON RISING LANETELEPHONE:
(617) 673-8000
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94158
CAPACITY:90CENSUS: 56DATE:
02/20/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Megan Cahill & Katika FulghamTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Mok conducted an unannounced case management inspection today. LPA met with the Site directors, Megan Cahill and Katika Fulgham. The purpose of the inspection was explained to them. There were 56 children with 24 staff present. The case management related to an unusual incident report that was submitted by the facility on 1/13/2020. The report related to the parents of a child informed the center on 1/6/2020 about the child was discovered not bearing weight on his right leg at home after being picked up from the center on Friday (1/3/2020). The child was taken to the ER and determined a hairline fracture on his right tibia. The facility conducted an internal investigation about the incident. The facility interviewed the staff and reviewed the Surveillance video footage but there was no sufficient evidence to prove the child was injured at school.


* No deficiency was cited during the inspection today. *








This report and notice of site visits were discussed with the licensee and must be made available to the public upon request. For a quarterly update on Licensing information, go to the CCL website: www.ccld.ca.gov. For Provider Information Notice: ccld.ca.gov/PG5098.htm.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy MokTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2020
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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