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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410518747
Report Date: 02/05/2020
Date Signed: 02/05/2020 11:22:45 AM

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:RCSD CHILD DEV SERVICES-HOOVER STATE PRESCHOOLFACILITY NUMBER:
410518747
ADMINISTRATOR:PENA, ROXANAFACILITY TYPE:
850
ADDRESS:701 CHARTER ST, PORT 1,2,3,& 4TELEPHONE:
(650) 482-2427
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94063
CAPACITY:105CENSUS: 83DATE:
02/05/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Site Supervisor, Roxana PenaTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA), Cindy Interiano conducted an unannounced case management inspection and met with Site Supervisor, Roxana Pena. Present during the inspection was Site Supervisor and 12 Staff supervising 85 PreK children.
Purpose of the inspection was to provide Facility with an updated License.

***No deficiencies were cited against the facility under CCR,Title 22, Div. 12, Ch. 1. ***

>This report and rights to comment and appeal were discussed with Site Supervisor. This report must be available in the facility for public review. Notice of site inspection was posted.
Site Supervisor were advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 02/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2020
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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