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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
013420945
Report Date:
08/31/2022
Date Signed:
09/15/2022 02:33:06 PM
Document Has Been Signed on
09/15/2022 02:33 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
,
1515 CLAY STREET STE 1102
OAKLAND
,
CA
94612
FACILITY NAME:
LITTLE FLOWERS MONTESSORI - BERNAL
FACILITY NUMBER:
013420945
ADMINISTRATOR:
BONNIE YIP
FACILITY TYPE:
850
ADDRESS:
3550 BERNAL AVE #120
TELEPHONE:
(925) 484-1005
CITY:
PLEASANTON
STATE:
CA
ZIP CODE:
94566
CAPACITY:
75
CENSUS:
26
DATE:
08/31/2022
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
09:50 AM
MET WITH:
Francesa Scalata
TIME COMPLETED:
12:50 PM
NARRATIVE
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Due to computer equipment being stolen on 08/31/2022-this is a
reproduced copy of the annual.
Signatures are on the original copy.
SUPERVISOR'S NAME:
Chandra Charles
TELEPHONE:
(510) 286-0966
LICENSING EVALUATOR NAME:
Lorraine Dacanay-Breaux
TELEPHONE:
(510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE:
08/31/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/31/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809
(FAS) - (06/04)
Page:
1
of
3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office
,
1515 CLAY STREET STE 1102
OAKLAND
,
CA
94612
FACILITY NAME:
LITTLE FLOWERS MONTESSORI - BERNAL
FACILITY NUMBER:
013420945
VISIT DATE:
08/31/2022
NARRATIVE
1
2
3
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5
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9
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SUPERVISOR'S NAME:
Chandra Charles
TELEPHONE:
(510) 286-0966
LICENSING EVALUATOR NAME:
Lorraine Dacanay-Breaux
TELEPHONE:
(510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE:
08/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/31/2022
LIC809
(FAS) - (06/04)
Page:
2
of
3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office
,
1515 CLAY STREET STE 1102
OAKLAND
,
CA
94612
FACILITY NAME:
LITTLE FLOWERS MONTESSORI - BERNAL
FACILITY NUMBER:
013420945
VISIT DATE:
08/31/2022
NARRATIVE
1
2
3
4
5
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Licensing doc 2.pdf
Licensing doc 3.pdf
licensing doc paper 1.pdf
SUPERVISOR'S NAME:
Chandra Charles
TELEPHONE:
(510) 286-0966
LICENSING EVALUATOR NAME:
Lorraine Dacanay-Breaux
TELEPHONE:
(510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE:
08/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/31/2022
LIC809
(FAS) - (06/04)
Page:
3
of
3