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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004124
Report Date: 11/06/2019
Date Signed: 11/06/2019 12:41:39 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:ARMENTA, JESSICA E.FACILITY NUMBER:
384004124
ADMINISTRATOR:ARMENTA, JESSICA E.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 347-7271
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94112
CAPACITY:14CENSUS: 10DATE:
11/06/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Jessica Armenta, Irma Cano, Cecilia RosalesTIME COMPLETED:
01:00 PM
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LPA Yee conducted a follow-up inspection today. There are 10 children, licensee and two helpers present today.

The following citations cited on 10/22 has been corrected.

1) Required immunization for both staff members are on file
2) Both staff members' fingerprint is cleared.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2019
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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