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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004156
Report Date: 08/23/2021
Date Signed: 08/23/2021 04:00:14 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: 9DATE:
08/23/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Chaya PotashTIME COMPLETED:
10:20 AM
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Licensing Program Analysts (LPA) Leslit Tapia-Mandujano conducted a required 1 year inspection in facility and met with licensee. Purpose of the inspection was explained. Present in the home is licensee, licensee's assistant, licensee's husband, and 9 children

Licensee rents a house with 3 bedrooms, 3 bathrooms, living/dining room, Great room, kitchen, and Roof deck. The great room is three steps lower from the main house. Hours of operation are Monday-Friday from 8:45am-3:30pm DAYCARE AREA: Great Room, Living/dining room, Bathroom #1, roof deck (walk through the home to get to the roof deck) OFF LIMITS AREA: Bedrooms (3), Bathroom #2 & #3, and Kitchen.

LPAs observed home for health and safety hazards. There is a variety of age appropriate toys and equipment in the home which are in good condition. There are no pools, spas, or bodies of water on the property. All cleaning supplies, poisons, and other chemicals are stored inaccessible to children. There is a working smoke detector and carbon monoxide detector, a fully charged fire extinguisher, and a working telephone. Per Licensee, there are no weapons/firearms or pets in the home. Per licensee, sick children are isolated and brought outside in the parklet. LPAs observed important postings posted in the wall of the Great room. Children's files were reviewed.

>No Deficiencies were cited today under CRR, Title 22, Division 12, Chapter 3. A copy of this report will be emailed to chayahecht@gmail.com. This report will be kept in the facility file and will be made available for public review upon request. Desk Duty is available Monday through Friday between 8AM - 5PM at (650) 266-8800.
SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8864
LICENSING EVALUATOR NAME: Leslit Tapia-MandujanoTELEPHONE: (650) 350-2554
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2021
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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