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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384000199
Report Date: 12/05/2022
Date Signed: 12/05/2022 12:50:22 PM

Document Has Been Signed on 12/05/2022 12:50 PM - It Cannot Be Edited

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:CHILDREN'S DAY SCHOOL, INC.FACILITY NUMBER:
384000199
ADMINISTRATOR:GREENE, ANTONETTE B.FACILITY TYPE:
850
ADDRESS:333 DOLORES STREETTELEPHONE:
(415) 861-5432
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY: 72TOTAL ENROLLED CHILDREN: 72CENSUS: 0DATE:
12/05/2022
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Antonette Greene, Shelly WilleTIME COMPLETED:
01:00 PM
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On 12/5/2022, 11:30AM., Regional Manager (RM), Suzanne Roman- Clark, Licensing Program Manager (LPM), Cindy Interiano, Licensing Program Manager (LPM), Daniel Oquendo, and Licensing Program Analyst (LPA), Luis Gomez, met with Site Director, Antonette Greene, and Head of School, Shelly Wille. The purpose of meeting was explained and was an informal/ office meeting, for personal rights violation cited on 11/2/2022, resulted from complaint received by the Department.

Site Director stated facility's follow-up actions include:
Facility has updated behavioral support plans to ensure children and families are properly supported with staff collaboration.

Training with staff included:
Review proper intervention techniques for children, including physical intervention only in extreme situations
Review of Personal Rights
Having team meetings once a week and division-wide monthly

Reporting Requirements was reviewed with facility.
During meeting, site director was provided teaching pyramid resources.

Site director was advised to post complaint investigation report (LIC9099, LIC9099D) and provide copy for parents/ authorized representatives of children in care. Also, to provided complaint report to newly enrolled families for the next 12 months. All families must sign the LIC9224, Notice of A-type deficiency.

Report was read and reviewed by all parties. Copy was provided to site director.
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 12/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2022
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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