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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384000322
Report Date: 11/16/2021
Date Signed: 11/16/2021 11:12:35 AM

Document Has Been Signed on 11/16/2021 11:12 AM - 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:LITTLE ANGELS JAPANESE PRESCHOOLFACILITY NUMBER:
384000322
ADMINISTRATOR:HIRAI, HISAMIFACILITY TYPE:
850
ADDRESS:1457 NINTH AVENUETELEPHONE:
(415) 564-6123
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94122
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 2DATE:
11/16/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Hisami HiraiTIME COMPLETED:
10:40 AM
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On November 16, 2021 at approximately 9:30am, Licensing Program Analyst (LPA) Winnie Ly conducted an Unannounced Case Management Visit at 2545 Judah Street and met with Site Director, Hisami Hirai during the visit. Purpose of the inspection was explained to licensee regarding her relocation application and other requirements that facility must meet in order to be licensed. Present during the visit were Director, her husband caring for 2 children. During today's visit, Ms. Kong from San Francisco Children's Council assisted in Japanese translation.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Winnie Ly
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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