Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002043
Report Date: 09/08/2015 12:00:00 AM
Date Signed 09/08/2015 12:46:29 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:FELLOM, JULIE ANNAFACILITY NUMBER:
384002043
ADMINISTRATOR:FELLOM, JULIE ANNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 971-4963
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94114
CAPACITY:14CENSUS: 6DATE:
09/08/2015
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Julie FellomTIME COMPLETED:
01:00 PM
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#3: LPA Huang met with Licensee Julie Fellom for a Case Management visit at this facility today. Purpose of the visit was explained to her. Present at the day care today were 2 staffs with 6 children in care. There were some parents with their children too. It is the orientation day today. The home was toured and inspected for health and safety hazards. This is a duplex house, 59 & 61 Grand view St. Julie is living in 59 Grand view which has 3 floors with 3 bedrooms. Licensee's partner owns this building. Current residents of the home are Licensee and her partner. Day care area is on the lowest level which include: play room, a small kitchen area, bathroom and the outdoor play area (the backyard). This level has direct access to the back yard for outdoor activity. Facility were also licensed to use the extra room and a nap room on the street level from the last visit. Off limits area are: upper 2 levels and the garage. The home is clean and orderly. At least one working smoke detector and one working telephone were tested. A 2A10BC fire extinguisher is fully charged. First aid supplies are available for children. Per licensee, there is no firearms or weapons in the home. Facility has Chickens and a Rabbit in the backyard. Facility conducts fire drills at lease once every month and was properly logged. There are plenty of variety of children's toys, tables, chairs and equipment that are available for children in the day care area and all appeared to be safe and age appropriate for children. Licensee is utilizing the children's roster and it is updated for this school year. A copy was obtained today. Parents rights poster and the License are posted. both helpers both have current pediatric CPR and First Aid training. Licensee is doing it this Saturday and she will mail a copy to CCL. Facility provides snack to children, parents provide entry. Disciplinary policy was discussed with licensee today. Facility records were reviewed. Facility has purchased liability insurance for the day care.

There is no deficiency cited today under CCR, Title 22, Division 12, Chapter 3:
This report and rights to comment were discussed with licensee. This report must be available in the facility for public review. Notice of site visit was posted.
SUPERVISOR'S NAME: Suzanne Roman-ClarkTELEPHONE: (650) 266-8843
LICENSING EVALUATOR NAME: Karen HuangTELEPHONE: (650) 266-8843
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2015
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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