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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004777
Report Date: 11/16/2021
Date Signed: 11/16/2021 04:45:58 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:CREATIVE LEARNING PRESCHOOLFACILITY NUMBER:
414004777
ADMINISTRATOR:SHIN BELLFACILITY TYPE:
850
ADDRESS:3399 CSM DR.TELEPHONE:
(415) 860-3386
CITY:SAN MATEOSTATE: CAZIP CODE:
94403
CAPACITY:10CENSUS: 0DATE:
11/16/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Ya Chien KoTIME COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) Glenn Schnell met with applicant Ya Chien Ko "Judy" for an additional pre licensing inspection to follow up on corrections needed from the initial pre licensing inspection conducted on 7/2/21. During today's inspection, the applicant requested to change the requested capacity from 10 to 23. The applicant updated the Application form LIC 200A during the inspection today. During today's inspection LPA Schnell inspected the physical plant inside and out and measured the outdoor activity space which now has a fenced in yard. The measurements of the outdoor space calculate to 1698.50 square feet, which equals 23 children. The climbing structure provides for shade and wood ships are used as the resilient material. Drinking water will be provided outdoors for children to have direct access to.

LPA Schnell will request an updated Fire Safety Inspection Request from the local fire department since the applicant has amended the application to a requested a capacity of 23 children.
Based on todays inspection, the previous corrections requested have been completed except the following corrections will need to be completed in order to process the request for a new capacity and approve the license for 23 children:

-Approved fire clearance for 23 children.
-Updated LIC 999 for indoor and outdoor space
-Updated LIC 401 based on 23 full time children
-Room numbers 105 & 106 needs to have all equipment removed that is not age appropriate for preschool age children.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Glenn A SchnellTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2021
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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