<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384003038
Report Date: 07/21/2021
Date Signed: 07/21/2021 12:54:20 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:SWEET PEAS PRESCHOOLFACILITY NUMBER:
384003038
ADMINISTRATOR:DIONNE, SAMANTHAFACILITY TYPE:
850
ADDRESS:1643 VALENCIA STREETTELEPHONE:
(415) 637-0796
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY:40CENSUS: 15DATE:
07/21/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Samantha Dionne, Grace WollTIME COMPLETED:
01:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 7/21/2021 at 9:05A.M. Licensing Program Analyst, (LPA) Luis J. Gomez met with Lead Teacher, Grace Woll at the facility. Purpose of inspection was explained and was an unannounced annual inspection. During Inspection, CEO Samantha Dionne arrived onsite. Preschool program operates two classrooms: Playroom, Large Classroom and the Outdoor Play Area. Hours of operation are Monday- Friday 8:00am- 4:30pm. The program operates year around. Present is the Lead Teacher, CEO and 3 staff supervising 15 children. All children present are preschool age. Children present were properly signed into facility. Facility was operating below capacity stated on license on this day. LPA inspected facility with for health and safety hazards.

At 9:10A.M., LPA inspected classroom and observed the following: Classrooms were clean, orderly and had a variety age appropriate toys, blocks and books for the children. All playthings inspected were in good repair. Playroom had carpeted areas for group reading time. Children’s individual cubbies are located in the entry way for added storage. Classrooms had several child size tables and chairs for snack and activities. Stackable napping cots are stored next to the children’s bathroom. Per CEO, linins are washed weekly by the facility. Children’s bathrooms were kept clean with adequate supplies. Staff use separate restroom located in hallway. Trash bins and outlets were properly covered.

At 9:25A.M., LPA inspected the outdoor door play areas. LPA observed, Outdoor play areas were completely enclosed with tall fencing. Play structure was properly anchored. All outdoor playthings were in good repair. Outdoor play area is kept clean and free of debris. For accessible fresh water, facility uses refillable pitchers and disposable cups. Outdoor Area is covered for child shading. Classrooms had ventilation and natural lighting. Facility had a smoke/ carbon monoxide detector combo and there are two fully charged fire extinguishers (3A:40BC) located in the playroom and large classroom. First aid kit was fully stocked. (REFER TO 809C FOR CONT.)

SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021
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 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: SWEET PEAS PRESCHOOL
FACILITY NUMBER: 384003038
VISIT DATE: 07/21/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
(Page 2)

At 10:00A.M., LPA reviewed children's files and four personnel files. LPA observed, children files reviewed were complete. Staff's CPR/ 1st aid certification is current expiring: 10/2021. At 10:10A.M., During file review, LPA observed teacher present without proper fingerprint association. At 10:56A.M., LPA observed teacher's personnel file without copy of transcripts .LPA reminded CEO to conducting required emergency disaster drill every 6 months. Licensing information was properly posted in facility hallway. Per CEO, program provides snack and families provide lunches.

Incidental Medical Services (IMS) was discussed. Per CEO, facility has no children who require IMS services at this time. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding Americans with Disabilities Act (ADA) was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) / (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: www.ada.gov/childqanda.htm.

During inspection,


· CEO was reminded, as of September 1, 2016, all Staff and Volunteers must provide proof of immunization against pertussis, measles, and influenza, or qualifies for an exemption, pursuant to Health and Safety code 1596.7995 and 1597.662.
· CEO was reminded about Mandated Reporter training available on CCLD website. Training must be completed every 2 years. Training can be done online at www.mandatedreporterca.com
· CEO was reminded about the Provider Information Notices (PINs) on CCLD website.
·LPA provided COVID-19 Technical Assistance guidance including: Child In-take procedure, Health safety review, Social distancing, Mask wearing and Regular disinfecting of high surfaces. (REFER TO PAGE 3 FOR CONT. )
SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: SWEET PEAS PRESCHOOL
FACILITY NUMBER: 384003038
VISIT DATE: 07/21/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
(Page 3)
Based on today's inspection, deficiencies were observed in the areas evaluated according the Title 22 Division 12 Ca. Code of Regulations. Plan of correction and exit interview was conducted with CEO, Samantha Dionne and her signature of this form acknowledges receipt of these documents. Appeal rights were provided during inspection.

>This report and rights to comment and appeal were discussed. This report must be available in the facility for public review. Notice of site inspection was posted. 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: 07/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SWEET PEAS PRESCHOOL
FACILITY NUMBER: 384003038
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/21/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/21/2021
Section Cited

1
2
3
4
5
6
7
101170(e)(2) Criminal Record Clearance. (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility (2) request a transfer of a criminal record clearance as specified in Section 101170(f). This requirement is not met as evidenced by:
8
9
10
11
12
13
14
Based on interviews and facility file review, LPA confirmed facility had teacher present without proper fingerprint association. This poses a potential health and safety risk to children in care.
8
9
10
11
12
13
14
Type B
07/28/2021
Section Cited

1
2
3
4
5
6
7
101616.2(d) Teacher Qualification and Duties. Original certified copies of transcripts verifying the completion of the required units shall be filed in each teacher's personnel file. This requirement is not met as evidence by:
8
9
10
11
12
13
14
Based on facility record review and observations, LPA confirmed lead teacher's personnel file does not have copy of transcripts. This poses a potential health and safety risk to children in care.
8
9
10
11
12
13
14
Proof of correction will be submitted to the department via email.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 07/21/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/21/2021
LIC809 (FAS) - (06/04)
Page: 4 of 4