Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002877
Report Date: 08/24/2017
Date Signed: 08/24/2017 02:07:39 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: 50DATE:
08/24/2017
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Crystal PlascenciaTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Mok conducted an unannounced POC inspection today. LPA met with a Crystal Plascencia`. The purpose of the inspection was explained to her. Per Crystal, Site Director, Marisol was out. Crystal was a person in charge of the center during her absence. There were 50 children with 15 staff present. The POC inspection was related to the deficiency that was cited on 7/31/2017 regarding some parents forgot to sign in the children. LPA inspected the sign in/out sheets. Facility was in compliance. The deficiency was cleared during the inspection.















This report was reviewed and provided to Crystal. The notice of site visit was given as well.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy MokTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2017
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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