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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004142
Report Date: 07/11/2019
Date Signed: 07/11/2019 04:02:17 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:STRYUK,ANASTASIA R.FACILITY NUMBER:
384004142
ADMINISTRATOR:STRYUK,ANASTASIA R.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 317-6060
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94112
CAPACITY:14CENSUS: 12DATE:
07/11/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Arina Takhtenova, Olga BasninaTIME COMPLETED:
04:30 PM
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Licensing Program Analyst, LPA Yee conducted a case management inspection today. There are 2 helpers and 12 children present today. One child left during the inspection. The facility now has 11 children in care. Licensee, Anastasia Stryuk is not present due to Jury Duty. Helpers CPR & 1st aid are not available today. Licensee will submit to LPA via email by the end of this week.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2019
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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