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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414000446
Report Date: 02/19/2021
Date Signed: 02/19/2021 11:07:45 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:PFS- CLUB LEO J. RYAN (SA)FACILITY NUMBER:
414000446
ADMINISTRATOR:PAIVI LANEFACILITY TYPE:
840
ADDRESS:1200 MILLER AVENUETELEPHONE:
(650) 952-6848
CITY:SOUTH SAN FRANCISCOSTATE: CAZIP CODE:
94080
CAPACITY:72CENSUS: DATE:
02/19/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Paivi LaneTIME COMPLETED:
11:00 AM
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Due to the current COVID-19 pandemic, field visits are suspended at this time.

Licensing Program Analyst (LPA) Andrea Medlin conducted this case management visit by tele-inspection and met with Paivi Lane. The purpose of this visit is due to a request to increase capacity and add a room/portable for child care purposes. Facility is currently licensed to serve 72 school aged children and requested an increase to accommodate up to 100 school aged children. South San Francisco Fire Department fire clearance was approved on 2/5/2021 for 100 school aged children. Days and hours of operation for the school aged program are: Monday-Friday 7:00AM-6:00PM. Facility is currently operating under temporary modified operating hours of 7:00AM-4:30PM due to the current COVID-19 pandemic and accommodating distance learning with school closure. Physical plant toured in the new requested areas to use for health and safety hazards. Facility is currently operating the school aged program in: portables/classrooms #3, #4, #31 and requesting to add new portable #29. There are fully charged fire extinguishers that meet minimum requirements, smoke detectors, and carbon monoxide (CO) detectors throughout the facility. Children's bathrooms inspected; all toilets and hand washing facilities are in safe and sanitary operating condition. Separate staff bathrooms are available. There are no changes to the outside school aged outdoor play areas.

This facility meets the licensing requirements to increase capacity to 100 children and re-licensure is recommended and approved as of today, 2/19/2021. New license shall be posted when received.

This report is reviewed with staff and provided by email. A copy of this report must made be available for public review upon request.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Andrea MedlinTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2021
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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