Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002637
Report Date: 09/30/2015 12:00:00 AM
Date Signed 09/30/2015 09:22:50 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: 12DATE:
09/30/2015
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
07:45 AM
MET WITH:Jolynn WashingtonTIME COMPLETED:
09:15 AM
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LPA Ng made a case management visit to the facility at issue, present was Jolynn Washington with 2 staff and 12 children. The reason for the visit was to discuss how the facility is providing for the needs and services of the children in the facility. In discussion with Ms. Washington the steps taken at this point is sufficient to provide a safe environment. LPA Ng will be updated as to the progress with the children at issue. There are no deficiencies observed on this visit.
SUPERVISOR'S NAME: Suzanne Roman-ClarkTELEPHONE: (650) 266-8843
LICENSING EVALUATOR NAME: Tony NgTELEPHONE: 650-266-8843
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2015
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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