Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002877
Report Date: 06/28/2017
Date Signed: 06/28/2017 12:39:10 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:PFS-BAYSHORE MIDWAY CDC (PS)FACILITY NUMBER:
414002877
ADMINISTRATOR:CREEDON, JEANNIEFACILITY TYPE:
850
ADDRESS:45 MIDWAY DRIVETELEPHONE:
(415) 330-1717
CITY:DALY CITYSTATE: CAZIP CODE:
94014
CAPACITY:95CENSUS: 78DATE:
06/28/2017
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Marisol OstorgaTIME COMPLETED:
12:50 PM
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Licensing Program Analyst (LPA) Mok conducted an unannounced case management visit to complete the inspection of the new classroom. LPA met with the site director, Marisol Ostorga. The purpose of the inspection was explained to her. There were 78 children with 24 staff that included 5 sub teachers present. Per licensee request, they needed a new classroom to be license, so they could move the children from Classroom #5 to #7 (it's called "ESL') by July 5, 2017. LPA already did the inspection on the ESL classroom on 6/14/17. LPA inspected the # 7 for the completion. Licensee already installed the 2 sinks for the children in the classroom. Facility also took down the counter along the wall that was across the bathroom and the sinks areas. The total measurement of the room was 1389.84, allowing 39 children. There were 2 toilets and 2 sinks in the classroom. Children from #7 will share the play ground with the children from other classrooms. Facility was granted with the Waiver of Schedule Playground already. Per licensee, fire marshal will conduct 2nd inspection on 6/29/17. If licensee needed to use the classroom by 7/5/17, Licensee needs to complete and submit the proof of correction to CCL by 6/30/17 for the approval.

Facility must complete the following items for the approval:
  • Fire inspection approval has to be received by CCL
  • All electrical outlets have to be covered across the sink area
  • Child proof knob has to be installed to the Staff office door.
  • Children's toilet on the left has to be fixed because it's not working.
  • The window lock has to be fixed at the Window #6 from the right that was facing to the play ground.
  • First aid kit has to be available in the classroom.


This report and notice of site visit were discussed with the licensee and must be made available to the public upon request. For quarterly update on Licensing information, go to CCL website: www.ccld.ca.gov. For Provider Information Notice: ccld.ca.gov/PG5098.htm

SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy MokTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2017
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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