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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414000931
Report Date: 09/06/2019
Date Signed: 09/06/2019 03:57:59 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:IHSD, INC-SOUTH SAN FRANCISCO HEAD START CENTERFACILITY NUMBER:
414000931
ADMINISTRATOR:YESSENIA FLORES-GUZMANFACILITY TYPE:
850
ADDRESS:825 SOUTHWOOD DRIVETELEPHONE:
(650) 368-1728
CITY:SOUTH SAN FRANCISCOSTATE: CAZIP CODE:
94080
CAPACITY:80CENSUS: 44DATE:
09/06/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Yessenia Flores-GuzmanTIME COMPLETED:
01:20 PM
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Licensing Program Analyst (LPA) Andrea Medlin met with director for this case management visit. Purpose of this visit is due to a self reported unusual incident. On 8/27/19, a child (C1) during outdoor time, the child walked to the perimeter of the playground where there is a curb separating the soft rubber areas and the cement area. The child lost his footing on the curb and fell resulting in an injury. Teacher's applied first aid and called parent. Parent took child to the hospital and treated. LPA inspected the outdoor play areas. LPA advised to place a visible bright colored strip, i.e. bright yellow or green along the cement curb to make it more visible. Children were also spoken to about safe play.

This appears to be an isolated incident and an accident.

This report is reviewed with director and a copy of this report must be made available for public review upon request.

Notice of site visit posted and shall remain posted for 30 days.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8867
LICENSING EVALUATOR NAME: Andrea MedlinTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2019
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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