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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384003095
Report Date: 11/05/2021
Date Signed: 11/05/2021 10:06:04 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:CITY SPROUTS PRESCHOOLFACILITY NUMBER:
384003095
ADMINISTRATOR:CULLINAN, REBECCAFACILITY TYPE:
850
ADDRESS:1466 38TH AVETELEPHONE:
(415) 971-1394
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94122
CAPACITY:15CENSUS: 15DATE:
11/05/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Rebecca CullinanTIME COMPLETED:
10:15 AM
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On November 04, 2021, Licensing Program Analyst (LPA) Winnie Ly met with Program Director Rebecca Cullinan for Case Management Visit to deliver the amended 809 report done on October 22, 2021. Present is the Director and 3 staff caring for 15 children.

During today's inspection, LPA Ly observed director sign amended 809 from inspection done on 10/22/2021 and signed today’s Case Management report.


No deficiencies were issued today under Title 22 Division 12 of the California Code of Regulations. A copy of the Amended report, Case Management report and appeal rights were discussed with Licensee whose signature on this form confirm receipt of these reports. Licensee was informed Notice of Site Visit to remain posted for 30 days upon receipt. For updates on Licensing information, go to CCL website: www.ccld.ca.gov. For Provider Information Notice: ccld.ca.gov/PG5098.htm
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Winnie LyTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2021
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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