Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002528
Report Date: 10/25/2017
Date Signed 10/25/2017 12:33:56 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:LUONG, NGOC KHANHFACILITY NUMBER:
384002528
ADMINISTRATOR:LUONG, NGOC KHANHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 418-4834
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94103
CAPACITY:14CENSUS: 4DATE:
10/25/2017
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Ngoc LuongTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Leung conducted a visit with Licensee Luong. During the visit, children went to the park with 2 helpers. Ms. Luong was working on a new preschool application. LPA discussed some of the questions that Ms. Luong have. LPA reviewed the blue print of the new center. The site is under construction. The Center application has been submitted to Licensing. Ms. Luong plans to open the new preschool in two months.
SUPERVISOR'S NAME: Suzanne Roman-ClarkTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2017
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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