Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002637
Report Date: 08/21/2015 12:00:00 AM
Date Signed 08/21/2015 11:22:50 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: 14DATE:
08/21/2015
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Jolynn WashingtonTIME COMPLETED:
11:30 AM
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LPA Ng made a prelicensing visit to the facility at issue, present was the Principal/Site Director Jolynn Washington with 5 staff and 14 children. All of the issues discussed on August 14, 2015 have been observed to be corrected. It is observed that the front and rear gates have been installed. The bench seats in the outside area are being repaired, but still needs to be resurfaced by August 28, 2015. Facility officials state that the door chimes that will be placed at the egress of the bathroom to room 001 have been ordered and once installed will supply pictures to LPA Ng. A mirror was also discussed on the August 14th visit, LPA observed that the mirror was present and awaits installation, a picture will be sent once installed. Construction in the preschool's premises have ceased. LPA has contacted Kristy Ouyang in regards to the waiver for scheduled outside use and she states that it has already been sent. LPA discussed issues with facilities in general with Principal Jolynn as a meet and greet. All items that are major and could create a health and safety issue have been rectified. Minor items will be verified by pictures and the bench is on going with a dead line of August 28, 2015. No further corrections are needed at this time.
SUPERVISOR'S NAME: Suzanne Roman-ClarkTELEPHONE: (650) 266-8823
LICENSING EVALUATOR NAME: Tony NgTELEPHONE: (650) 266-8843
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2015
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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