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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414001575
Report Date: 07/29/2022
Date Signed: 08/03/2022 02:16:57 PM


Document Has Been Signed on 08/03/2022 02:16 PM - It Cannot Be Edited

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 OF PACIFICA - SUNSET RIDGE CHILDREN'S CENTERFACILITY NUMBER:
414001575
ADMINISTRATOR:CYNTHIA USSERYFACILITY TYPE:
850
ADDRESS:340 INVERNESSTELEPHONE:
(650) 738-7465
CITY:PACIFICASTATE: CAZIP CODE:
94044
CAPACITY:24CENSUS: 0DATE:
07/29/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Theresa GutierrezTIME COMPLETED:
01:10 PM
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On July 29, 2022, Licensing Program Analyst (LPA) arrived at the facility for a 1-Year annual inspection. LPA met with Theresa Gutierrez of the after school program, who states that the preschool closed for the summer on June 27, 2022, and will not reopen until August 17, 2022.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April CowanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 08/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/03/2022
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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