Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002241
Report Date: 12/19/2018
Date Signed 12/19/2018 02:37:40 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: 25DATE:
12/19/2018
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Lien TuTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Mok conducted an unannounced case management inspection. LPA met with the site director, Lien Tu. The purpose of the inspection was explained to her. There were 25 children with 5 staff present. The case management was related to one of the toilets in the upper classroom that was not working properly during the inspection on 11/15/18. LPA inspected the toilet during the inspection. The facility already fixed the issue. The toilet worked properly during the inspection.

This report was reviewed and provided to the Site Director. 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: 12/19/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2018
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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