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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
414002316
Report Date:
01/10/2020
Date Signed:
01/10/2020 04:33:55 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:
LANZA, SANDRA
FACILITY NUMBER:
414002316
ADMINISTRATOR:
PADILLA, A. & LANZA, S.
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(650) 871-7945
CITY:
SOUTH SAN FRANCISCO
STATE:
CA
ZIP CODE:
94080
CAPACITY:
14
CENSUS:
4
DATE:
01/10/2020
TYPE OF VISIT:
POC
UNANNOUNCED
TIME BEGAN:
03:55 PM
MET WITH:
Sandra Lanza
TIME COMPLETED:
04:40 PM
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Licensing Program Analyst (LPA) Andrea Medlin met with Licensee for this plan of correction visit established on 12/13/2019. There are 4 children present during the visit. The following previously cited deficiencies are checked today:
Section 102418(g) -
Immunization. Licensee shall document and maintain each child’s immunizations as long as the child is enrolled. C1 now has verification of current immunization records.
This report is reviewed with Licensee and a copy of this report must be made available for public review upon request.
SUPERVISOR'S NAME:
Garfield Leung
TELEPHONE:
(650) 266-8800
LICENSING EVALUATOR NAME:
Andrea Medlin
TELEPHONE:
650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE:
01/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
01/10/2020
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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