Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002637
Report Date: 08/14/2015 12:00:00 AM
Date Signed 08/14/2015 11:28:03 AM

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:SFUSD-JOSE ORTEGA ES (EED) PSFACILITY NUMBER:
384002637
ADMINISTRATOR:JOLYNN T. WASHINGTONFACILITY TYPE:
850
ADDRESS:400 SARGENT ST, RM 001 & B-8TELEPHONE:
(415) 750-8505
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94132
CAPACITY:48CENSUS: 0DATE:
08/14/2015
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
07:45 AM
MET WITH:Kristy OuyangTIME COMPLETED:
11:45 AM
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This is a prelicensing visit conducted by LPA Ng to process the application to use Room 001 and B-8. Facility is currently operating in the Jose Ortega School. LPA met with director Kristy Ouyang. Kristy gave LPA a tour of the areas to be used by the program. The following were observed during the visit. LPA inspected Rooms 001 and B-8. The outdoor playground was inspected, observed is an age appropriate play structure, Kristy states that the sturcture was ordered to serve children ages 3 to 5. There are 2 toilets in each room as well as 2 basins. In room B-8 there is a diaper changing table, and the rules and regulations pertaining to the diaper changing table was explained to the teacher as well as Kristy. The classroo is set up with tables and chairs and other equipment for children, furniture is age appropriate and enough to support the capacity applied for. First aid supplies are available. Facility has all the required documents to be posted. Water is available via water fountains to children in the classroom and playground. The school office will be used to isolate ill children. Pediatric CPR and first aid training is current. Kristy told LPA that medication is provided to children with parent's note and is a prescription. LPA advised Kristy that fire drills and disaster drills are to be conducted per regulations. The program serves a breakfast and lunch to the children and will be catered by revolution foods. The fire department has granted clearance. The facility will be recommended for licensure. The program will start 08/17/2015. However the following will be observed:
1. The rear and front gates must be available by the start of school.
2. The bench of the outside is observed to be rotted, the bench will be replaced and if not in time to be covered. This however will be done by August 28, 2015
3. Install a door chime at the bathroom door for room 001
4. Advise to place a mirror at the bathroom in room 001.
5. All construction in the child care areas must be completed and the environment free of hazards.
6. Waiver request for outdoor scheduled use.

LPA will return on the day school starts to verify that the environment is safe for operation.
SUPERVISOR'S NAME: Suzanne Roman-ClarkTELEPHONE: (650) 266-8823
LICENSING EVALUATOR NAME: Tony NgTELEPHONE: (650) 266-8843
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2015
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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