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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002757
Report Date: 11/15/2021
Date Signed: 11/15/2021 04:39:01 PM

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:SF TIKES ACADEMYFACILITY NUMBER:
384002757
ADMINISTRATOR:SHIMKUNAS, SARAHFACILITY TYPE:
850
ADDRESS:1218 SOUTH VAN NESS AVENUETELEPHONE:
(415) 826-8222
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY:117CENSUS: 61DATE:
11/15/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
04:05 PM
MET WITH:Director, Sarah Shimkunas.TIME COMPLETED:
04:35 PM
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On 11/15/2021 at 4:25P.M, Licensing Program Analyst (LPA) Luis J. Gomez met with Director, Sarah Shimkunas. Purpose of inspection was explained and was Plan of Correction, established on 11/3/2021. Present was director and 8 staff supervising 61 children. LPA inspected facility with the licensee for health and safety hazards.

During inspection, submitted updated staff schedule with proper staff-child ratios. Deficiency issued on 11/3/2021 have been cleared. 'Cleared POC Letter' was provided.

Based on today's inspection, no deficiencies were observed in the areas evaluated according the Title 22 Division 12 Ca. Code of Regulations. Exit interview was discussed with the director Sarah Shimkunas, and her signature of this form acknowledges receipt of these documents.

This report and rights to comment were discussed. This report must be available in the facility for public review. Notice was given and must remain posted for 30 days. Facility was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov
SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2021
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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