Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002241
Report Date: 05/26/2017
Date Signed 05/26/2017 01:22:23 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:CCFC-VV TUCKER CENTER (P)FACILITY NUMBER:
384002241
ADMINISTRATOR:FONDA DAVIDSON, EXEC. DIR.FACILITY TYPE:
850
ADDRESS:103 TUCKER AVENUETELEPHONE:
(415) 921-7019
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94134
CAPACITY:40CENSUS: 22DATE:
05/26/2017
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Nakita ChowTIME COMPLETED:
01:50 PM
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Licensing Program Analyst (LPA) Mok conducted an unannounced POC inspection. LPA met with the site director, Nakita Chow. The purpose of the inspection was explained to her. There were 22 children with 4 staff present. The POC was related to the deficiency that was issued on 5/17/17 regarding a faucet on the left didn’t work in children’s bathroom in the upper classroom. Licensee corrected the POC by using another sink in the classroom. The broken faucet will be replaced soon. The deficiency was cleared during inspection.




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

DATE: 05/26/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2017
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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