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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004021
Report Date: 09/12/2019
Date Signed: 09/12/2019 10:18:47 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:CREATIVE MONTESSORI PRESCHOOLFACILITY NUMBER:
384004021
ADMINISTRATOR:YANG, YANGFACILITY TYPE:
850
ADDRESS:3101 VICENTE STREETTELEPHONE:
(415) 661-2828
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94116
CAPACITY:52CENSUS: 47DATE:
09/12/2019
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Yang YangTIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Winnie Ly conducted a Case management - Annual Continuation visit and met with Site Director, Yang Yang during the visit. Purpose of the inspection was explained. There are 48 children 8 staff members. Teacher to child ratios were met on this day.

LPA is conducting a case management-annual continuation due to FAS was performing consistency check while the Site Director was signing her Facility Evaluation Reports. LPA had to leave the facility to wait for FAS to be back on. Therefore, LPA is present at the facility again today to finish up having the Site Director sign her reports.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Winnie LyTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2019
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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