Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380504442
Report Date: 02/08/2017
Date Signed: 02/08/2017 04:49:49 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:SFUSD-NORIEGA EARLY EDUCATION SCHOOL (PS)FACILITY NUMBER:
380504442
ADMINISTRATOR:NG, IVYFACILITY TYPE:
850
ADDRESS:1775 - 44TH AVENUETELEPHONE:
(415) 759-2853
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94122
CAPACITY:136CENSUS: 68DATE:
02/08/2017
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Chin Yu ChanTIME COMPLETED:
05:00 PM
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LPA Ng made a closing case management visit to the facility at issue, present was the head teacher Chin Yu Chan, with 13 staff and 63 children in 4 rooms. The reason for the visit was to close a incident investigation that occurred 09/23/15. Information available shows that the child was not hurt by staff and there are no deficiencies found in this matter. The facility had self reported the issue. The child is still currently enrolled in the program.
SUPERVISOR'S NAME: Suzanne Roman-ClarkTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Tony NgTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2017
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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