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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408883
Report Date: 11/09/2021
Date Signed: 11/09/2021 04:27:42 PM

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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:SYCAMORE VALLEY DAY SCHOOLFACILITY NUMBER:
073408883
ADMINISTRATOR:DEYHIM, FEDRAFACILITY TYPE:
830
ADDRESS:1500 SHERBURNE HILLS ROADTELEPHONE:
(925) 736-2181
CITY:DANVILLESTATE: CAZIP CODE:
94526
CAPACITY:7CENSUS: 4DATE:
11/09/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:26 AM
MET WITH:DEYHIM, FEDRATIME COMPLETED:
04:45 PM
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On 11/09/2021, at 08:50 AM., Licensing Program Analysts (LPAs) L. Chew and L. Dyer arrived to facility. LPAs conducted a joint unannounced Annual Required Inspection. LPAs met with Director Fedra Deyhim, Inspection will be completed at a later date. LPAs departed facility at 4:45 PM.
No deficiency was cited during today’s inspection. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Director, DEYHIM, FEDRA.
SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) -69-0243
LICENSING EVALUATOR NAME: Lakeisha ChewTELEPHONE: (510) 566-5850
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2021
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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