Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001885
Report Date: 02/08/2017
Date Signed 02/08/2017 01:59:17 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:SFSU - CHILDREN'S CAMPUS (INFANT)FACILITY NUMBER:
384001885
ADMINISTRATOR:TOBIN-WALLIS, ANNAFACILITY TYPE:
830
ADDRESS:N. STATE DR.&LAKE MERCED BLVD.TELEPHONE:
(415) 405-4011
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94132
CAPACITY:36CENSUS: 36DATE:
02/08/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Anna Tobin-WallisTIME COMPLETED:
12:30 PM
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3, Licensing Program Analyst, LPA Yee conducted an annual random visit today. I met with site director, Anna Tobin-Wallis, 13 staff members and 36 children. The purpose of the visit was explained. LPA toured and inspected the facility for health and safety hazards with Anna. The facility has 4 classrooms (Hummingbird (118), Chickadee (121), Sparrow (120), Robin (119). This is an all day program. There are plenty of age appropriate toys and equipment available for children. Diaper changing table is within arm reach to a sink. There are sufficient cribs, cots and mats available for children. Per director, disaster drills were conducted 2 weeks ago on January 30th. First Aid supplies are available in the classroom. Incidental medical services, IMS plan was discussed. A written policy was obtained during the visit. Facility was informed that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662. Children files and staff records were reviewed today. Staff has evidence of current health and safety training in CPR and First Aid. Facility personnel summary report was reviewed with Anna and current. During the visit, LPA obtained current LIC500 and LIC610. Facility meets all posting requirements and licensing fees are current.

This report and rights to appeal is discussed and explained with the Director. Website for Forms and Regulations: www.ccld.ca.gov.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (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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