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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004387
Report Date: 10/28/2021
Date Signed: 10/28/2021 12:08:40 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:LITTLE PANDA PRESCHOOLFACILITY NUMBER:
384004387
ADMINISTRATOR:JOY OUELLETTEFACILITY TYPE:
850
ADDRESS:205 GRANADA AVENUETELEPHONE:
(415) 990-1930
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94112
CAPACITY:55CENSUS: 17DATE:
10/28/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Jiemin Zhang aka TiffanyTIME COMPLETED:
12:30 PM
NARRATIVE
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Licensing Program Analysts (LPA) Yee conducted a case management inspection today. Present at the facility are the owner, Tiffany, two staff members, and 17 children. The facility was approved for 55 children and requested to add 3 more children. Total useable indoor areas measure at 2,031.43 sq ft which allows 58 children. The measurement was measured by LPA Schnell on 5/18/2021. The new fire clearance allowing for 58 children is on file. During the inspection, LPA obtained a new waiver request from the facility.

LPA went over the facility personnel summary with Tiffany. The two staff members do not have fingerprint clearance/association on file. Civil penalty of $100 was issued today.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021
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 2
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: LITTLE PANDA PRESCHOOL
FACILITY NUMBER: 384004387
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/28/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/28/2021
Section Cited

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101170- Criminal Record Clearance.
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code

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Section 1596.871 shall prior to working, residing or volunteering in a licensed facility. This requirement is not met evidenced by director was unable to provide any documentation of the clearance. LPA checked the LIS. Teacher does not have clearance. This poses an immediate Health and Safety or Personal Rights risk to the children in care. Civil Penalty of $100 was issued.
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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: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 10/28/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/28/2021
LIC809 (FAS) - (06/04)
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