Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380505210
Report Date: 05/07/2015 12:00:00 AM
Date Signed 05/07/2015 10:11:13 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:ULLOA CHILDREN'S CENTERFACILITY NUMBER:
380505210
ADMINISTRATOR:WANG, CAILINGFACILITY TYPE:
840
ADDRESS:2650 42ND AVENUETELEPHONE:
(415) 759-8854
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94116
CAPACITY:120CENSUS: 33DATE:
05/07/2015
TYPE OF VISIT:Required - 5 YearUNANNOUNCEDTIME BEGAN:
07:45 AM
MET WITH:Timothy LopezTIME COMPLETED:
10:25 AM
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Licensing Program Analyst (LPA) Huang met with Assistant Director Timothy Lopez for a 5 year required visit today at this facility. Director Cailing Wang was busy with children in the Gym, practicing dance. Present at the facility were also 3 Teachers and 1 Teacher Aid with 33 children in care. The program operates in a functioning school site, the SFUSD Ulloa Elementary School. Day care areas are: the tutoring room, the Gym, boys and girls bathrooms, and the outdoor playground. Facility meets teacher/child ratio today. LPA toured the facility for health and safety hazard. There are tables and chairs in the tutoring room for children to do their home work. The Gym area is adjacent to the tutoring room. The Director was teaching a group of children dancing at the Gym. The boys bathroom is in the Gym area with 2 urinals, two toilets and two sinks. The Girls bathroom is in the tutoring room that has 3 toilets and 2 sinks. There are also other two girls and two boys bathrooms available for children at the other side of the school by the playground area. Medication policy was discussed, it meets licensing regulations. The center provides snacks only and are prepared at the center. First aid supplies are available in the classroom. Isolation area will be in the kitchen area next to the classroom. At least one staff has current pediatric CPR and First Aid training. The center share the front part of the playground areas with the elementary school. There is a play structure with rubberized cushioning. Water is available for children during outdoor activity. Facility has posted the required forms (ie License, menus, Notification of Parent's Rights, Notification of Personal Rights, Car Seat Law, and Emergency Disaster Plan). Fire and Earthquake drills are done each month and are properly logged in the main office. All Children have signed in today.

There is no deficiency cited against the facility under CCR,Title 22, Div. 12, Chapt. 1:

This report was discussed with the director and must be available for public review. Notice of site visit was posted.
SUPERVISOR'S NAME: Suzanne Roman-ClarkTELEPHONE: (650) 266-8823
LICENSING EVALUATOR NAME: Karen HuangTELEPHONE: (650) 266-8843
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2015
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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