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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380504354
Report Date: 01/18/2024
Date Signed: 01/18/2024 04:07:01 PM

Document Has Been Signed on 01/18/2024 04:07 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
SAN BRUNO CC RO, 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: 23DATE:
01/18/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Oscar ChavezTIME COMPLETED:
04:15 PM
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On 1/18/2024 at 3:15PM Licensing Program Analyst (LPAs) Luis Gomez and Yasha Nasiripour met Teacher, Oscar Chavez. Purpose of the inspection was explained and was for an unannounced, plan of correction inspection established on 12/19/2023. Present was the lead teacher and 4 staff supervising 23 children. Children present had been properly signed in. LPAs inspected facility, indoors and outdoors, for health and safety hazards.

During inspection, LPAs performed record review, observations, and interviews.


LPAs observed staff, S1, current cardiopulmonary resuscitation (CPR)/ first aid certification on file. Per teacher, training was completed in-person and expires: 4/29/2025.

LPAs reminded facility to ensure staff's training certificates are stored in the personnel records.

Deficiency issued on 12/19/2023, have been cleared, and ‘Cleared Plan of Correction Letter’ was provided.

Exit interview and inspected report was discussed with Lead Teacher, Oscar Chavez. Lead Teacher's signature of this form acknowledges receipt of these documents.

This report must be available in the facility for public review. Notice was provided and shall remain posted for 30 days. Director was advised for additional questions to call CCL Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/18/2024
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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