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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004156
Report Date: 08/10/2021
Date Signed: 08/10/2021 02:39:30 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:POTASH, CHAYA M.FACILITY NUMBER:
384004156
ADMINISTRATOR:POTASH, CHAYA M.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 797-7231
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94117
CAPACITY:14CENSUS: DATE:
08/10/2021
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Chaya PotashTIME COMPLETED:
02:40 PM
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Licensing Program Analyst (LPA) Tapia-Mandujano met with licensee, Chaya Potash to conduct a case management inspection per licensee’s request to add the roof deck as a part of the day care area. Licensee will reopen daycare on August 17th, 2021. LPA and licensee toured the home for health and safety hazards.

Licensee rents a two level house with 3 bedrooms, 3 bathrooms, living/dining room, Great room (on the street level), kitchen, and Roof deck. The Applicant lives in the back and the Family Child Care is in the front. Hours of operation are Monday-Friday are from 8:45am-3:30pm DAYCARE AREA: Great Room, Bathroom #1, roof deck (walk through the home to get to the roof deck) OFF LIMITS AREA: Entire back house (3 Bedrooms, Bathroom #2 & #3, Living/dining room, and Kitchen)

LPA toured the day care area and observed that day-care area is clean, and home has proper lighting and ventilation. LPA inspected the roof deck. The roof deck was clean and spacious. LPA did not observe any harmful objects or substances. Licensee states that she will only use the roof deck for outside play.

Based on observation, LPA approves the roof deck for outside play.

Copy of this report was emailed to the licensee. Signed copy of this report will be kept in the facility file and made available for public review. Desk Duty is available Monday through Friday between 8:00 AM - 5:00 PM at (650) 266-8800. Website for forms and Regulations: www.cdss.ca.gov
SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8864
LICENSING EVALUATOR NAME: Leslit Tapia-MandujanoTELEPHONE: (650) 350-2554
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2021
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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