Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002299
Report Date: 09/12/2018
Date Signed: 09/12/2018 11:30:56 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:C5 CHILDREN'S SCHOOL-SFPUC (PS)FACILITY NUMBER:
384002299
ADMINISTRATOR:WISEMAN, JOSEPHFACILITY TYPE:
850
ADDRESS:525 GOLDEN GATE AVENUETELEPHONE:
(415) 626-4880
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94102
CAPACITY:45CENSUS: 21DATE:
09/12/2018
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Sheran LoTIME COMPLETED:
11:30 AM
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LPA Ng made a POC visit to the facility at issue, the reason for the visit was explained to the Director. There were 21 children with 4 staff persons on today's visit. LPA discussed the importance of supervision as well as deciding what age appropriate toys can be used for children. LPA advised that the director should make the final decisions as to a toy being approved and how to store items safely if the item should be used with only with adult supervision. Items that are created from the minds of the staff as opposed to being bought with it's intended purpose should also be scrutinized, for example: rope climbing, LPA advised the director to explore all aspects both negative and positive and if there are dangers can it be prevented. The deficiencies have been corrected through staff training there were no further deficiencies observed on this visit.
SUPERVISOR'S NAME: Suzanne Roman-ClarkTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Tony NgTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2018
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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