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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380504354
Report Date: 12/13/2022
Date Signed: 12/13/2022 05:31:19 PM

Document Has Been Signed on 12/13/2022 05:31 PM - It Cannot Be Edited

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-ZAIDA T. RODRIGUEZ (EES) PRESCHOOLFACILITY NUMBER:
380504354
ADMINISTRATOR:MANCINA, JANEFACILITY TYPE:
850
ADDRESS:2950 MISSION STREETTELEPHONE:
(415) 695-5842
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 14DATE:
12/13/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Laylay Eung TIME COMPLETED:
05:35 PM
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On 12/13/2022 at 3:15PM. Licensing Program Analyst, (LPA) Luis J. Gomez met with Lead Teachers, Oscar Chavez, Laylay Eung. The purpose of today's inspection was explained and is in response to an incident occurring on 10/25/2022. Incident was self- reported to the department by SFUSD Administration. Present were the Lead Teachers and 5 staff supervising 14 children. All children present had been properly signed-in. LPA inspected facility, indoors and outdoors, with lead teachers for health and safety hazards.

During the inspection, LPA performed site observations, interviewed staff and involved parties.

Incident reported involved a day-care child, C1, who had been forced by staff member to eat the school- provided lunch, after having refused several times. Incident was witnessed by staff members and the child’s authorized representatives were informed.

Per School Principal, incident initiated an subsequent investigation. Investigation confirming that violation in the child’s personal rights had occurred. As a result of the incident, three staff members received ‘Written Reprimands’ by the school district. Administrator and all classroom personnel involved also reviewed, SFUSD food policy and Title 22 regulation regarding children’s personal rights.

***No deficiencies were cited against the facility under CCR,Title 22, Div. 12, Chapt. 1. ***

This report and rights to comment and appeal were discussed with Lead Teacher. This report must be available in the facility for public review. Notice of site inspection was posted. Any additional questions to call Office, M-F, 8a-5p, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 12/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/13/2022
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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