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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004479
Report Date: 10/03/2019
Date Signed: 10/03/2019 11:04:07 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: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: 0DATE:
10/03/2019
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Irena (Shu) Yang TIME COMPLETED:
11:15 AM
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Licensing Program Analysts (LPAs) Andrea Medlin and Winnie Ly met with applicant for this scheduled prelicensing visit. Physical plant toured including indoor and outdoor space. Days and hours of operation will be Monday-Friday 8:00AM-6:00PM. Per Applicant, the lot is divided by two separate addresses; this facility is 374 Catherine Drive and the next door neighbor/tenant address is unknown at this time. Outdoor area is completely fenced with age appropriate play structures.

Indoor space is measured and inspected today for health and safety hazards. Indoor space is divided by two separate areas. For the "Panda" classroom, it measures 1688 square feet allowing for a capacity of 48 children; "dolphin" classroom measures 585 square feet allowing for a capacity of 16 children. Outdoor play areas measures 650 square feet allowing for 8 children. There are a total of 4 sinks, and 4 toilets available for children's use allowing for 60 children. There is a separate staff bathroom available. Isolation area for a sick child will be in the staff office. All children in the isolation area will need to be visually supervised at all times. Fire clearance was granted by South San Francisco Fire Department on 8/26/19 for 60 children. Facility will request an outdoor rotation waiver due to insufficent outdoor playground space. The maximum capacity facility could be licensed for is 8 children. Final licensure requested capacity is not yet determined due to insufficient outdoor space.

Facility is adequately furnished with age appropriate toys, furniture, equipment, and first aid supplies. There are fire extinguishers, smoke detectors, and a carbon monoxide (CO) detector present; however the fire extinguisher does not meet licensing requirements.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8867
LICENSING EVALUATOR NAME: Andrea MedlinTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2019
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 PRESCHOOL
FACILITY NUMBER: 414004479
VISIT DATE: 10/03/2019
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Napping equipment is available; facility will use soft cushioned foldable mats and cots for the children. Parents/guardians will provide the napping sheets and will be responsible to wash once a week. Parents will provide the meals; facility will provide snacks.

Earthquake/fire drills will be conducted and logged at least once every six months. Sign in and sign out log is electronic. The required licensing forms are posted: Notification of Parent's Rights, Notification of Personal Rights, Earthquake preparedness checklist, and Emergency Disaster Plan. Once license is approved and received, license must be posted in a prominent accessible location in view of parents/guardians.

Prior to licensure:

  • Approval of outdoor rotation playground waiver
  • Appropriate size fire extinguisher 2A:10BC
  • Meet all City of South San Francisco zoning and fire codes a listed in "Notice of Action" South San Francisco Planning Commission
  • Address of facility needs to be verified

Final licensure will be pending Department review and approval.

Once all the above has been approved, licensure will then be recommended and approved.




This report is reviewed with applicant and a copy of this report must be made available for public review upon request.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8867
LICENSING EVALUATOR NAME: Andrea MedlinTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2019
LIC809 (FAS) - (06/04)
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