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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 210102930
Report Date: 08/11/2022
Date Signed: 08/11/2022 03:19:59 PM


Document Has Been Signed on 08/11/2022 03:19 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:SAN GERONIMO PRESCHOOL & CHILDCARE CENTERFACILITY NUMBER:
210102930
ADMINISTRATOR:SHARON DAHMEFACILITY TYPE:
850
ADDRESS:6001 SIR FRANCIS DRAKE BLVD.TELEPHONE:
(415) 488-4655
CITY:SAN GERONIMOSTATE: CAZIP CODE:
94963
CAPACITY:24CENSUS: 6DATE:
08/11/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Bernice WestTIME COMPLETED:
01:45 PM
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On August 11, 2022 at approximately 1:00pm, Licensing Program Analyst (LPA) Winnie Ly conducted an Unannounced Case Management Visit for an increase of capacity and met with Teacher Bernice West during the visit. Purpose of the inspection was explained. There were 6 children and 3 staff members present during the inspection.

Currently facility is licensed for 16 preschool children and 8 toddlers. Facility is requesting for an increase to 18 preschool children in the preschool classroom. On this day LPA measured the preschool classroom with a total of 720 sq. feet. LPA also observed classroom has 2 toilets and 2 sinks. With 720 sq feet, the preschool classroom has enough space for 18 preschool children as requested. Facility has Fire Clearance granted by the Marin County Fire Department.

Facility's preschool classroom has been approved to hold 18 preschool children.

No deficiencies were issued today under Title 22 Division 12 of the California Code of Regulations. A copy of this report was discussed and left with Teacher Bernice West whose signature on this form confirm receipt of the report. Notice of Site Visit was posted. Notice to remain posted for 30 days. 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: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Winnie LyTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 08/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/11/2022
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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