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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384003038
Report Date: 09/17/2021
Date Signed: 09/17/2021 10:32:45 AM

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: 14DATE:
09/17/2021
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Licensee, Samantha Dionne TIME COMPLETED:
10:35 AM
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On 9/17/2021 at 9:00A.M. Licensing Program Analyst (LPA), Luis J. Gomez met with Licensee/Director, Samantha Dionne. Purpose the inspection was explained and is an announced Case Management inspection to update the facility file. San Francisco Fire Inspector, Ko was also present during inspection. Present was the Licensee/Director and five staff caring for 14 children. All children present are preschool age. Preschool program operates in two classrooms: Playroom, Large Classroom and the Outdoor Play Area. Hours of operation are Monday- Friday 8:00am- 4:30pm. The program operates year-a-round. LPA inspected facility, indoors and outdoors, for Health and Safety Hazards.

During inspection, Fire Inspector Ko provided facility with plan of correction to update the Fire Clearance Approval Request (STD 850). Licensee/Director agreed to complete plan of correction. LPA will submit updated Fire Clearance Approval Request via email. LPA and Licensee also reviewed additional documents to be updated in the facility file.

During Inspection Licensee submitted: LIC9211 and LIC9182.

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 conducted with Licensee/Director Samantha Dionne 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 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: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021
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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