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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004479
Report Date: 08/12/2019
Date Signed: 08/12/2019 04:51:58 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:GOLDEN STATE PRESCHOOLFACILITY NUMBER:
414004479
ADMINISTRATOR:SU, SONIAFACILITY TYPE:
850
ADDRESS:374 CATHERINE DRIVETELEPHONE:
(415) 990-1354
CITY:SOUTH SAN FRANCISCOSTATE: CAZIP CODE:
94080
CAPACITY:60CENSUS: 17DATE:
08/12/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Grace Chen and Irene TruongTIME COMPLETED:
05:00 PM
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Licensing Program Manager (LPM) Malig and Licensing Program Analyst conducted an unannounced Case Management visit. Present at the facility front are 2 staff and 10 pre school age children. Present at the back of the facility are 7 children and 1 staff doing Art Class. The staff in the Art Class states that she is not affiliated with the preschool in front. LPM and LPA observed the facility and it is still under construction inside and outside.
This is a home in a residential area converted into a Child Care Center.

LPM and LPA's observed health and safety hazards during the inspection. One section of the home is converted into a pre school classroom divided into different equipment with 4 child size toilets and one covered and not operational. There 3 sinks available.
LPM and LPA observed Safety violations;
~~Storage and Utility Room full of dangerous materials such as water heater accessible to children in care.
~~Bleach/Lysol and other cleaning solution under the sink also accessible to children in care.

The other section of the home facing Catherine Drive, is still under construction. LPA and LPM observed a power tool on top of the double sink. Both staff were asked where is the owner, Irina Yang ? both states "we don't know where she is"


This facility was issued a Notice Of Violation to ceased Operation in December 12, 2018.
On January 25, 2019 a Denied of the Application was also issued .

SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Winnie LyTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2019
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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