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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004525
Report Date: 07/09/2024
Date Signed: 07/09/2024 11:55:25 AM

Document Has Been Signed on 07/09/2024 11:55 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:SWEET PEAS TOOFACILITY NUMBER:
384004525
ADMINISTRATOR/
DIRECTOR:
DIONNE, SAMANTHAFACILITY TYPE:
830
ADDRESS:2730 17TH STREETTELEPHONE:
(415) 701-0495
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY: 32TOTAL ENROLLED CHILDREN: 32CENSUS: 16DATE:
07/09/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:45 AM
MET WITH:Samantha DionneTIME VISIT/
INSPECTION COMPLETED:
12:05 PM
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On 7/9/2024 at 10:45AM., Licensing Program Analysts (LPAs) Luis Gomez and Zeynep Basak and met with Director, Samantha Dionne. The purpose of today’s inspection was explained and was for an unannounced, plan of correction inspection. Present was the Director and 5 staff supervising 16 children. Children present had been signed in by guardians. LPA inspected facility for health and safety hazards.

During today's inspection, LPA conducted record review, observation, and interview.

LPAs reviewed facility records, including the staff files.
Staff S1’s files were reviewed and including the: LIC9108 and LIC508. Per director, staff S1, will not be returning until proof of required immunization are received by facility.

LPAs observed two potential staff present in facility. Per director, potential staff are here for a visit, and are not part of the required ratio. LPA advised director to ensure adult, who comes in contact with children, are fingerprinted and associated prior to presence in facility. Advisory Note: Technical Violation (LIC9102TV) was issued.

LPAs advised director to remove all sleep sacks from facility.

1 of 3 deficiencies issued on 7/2/2024 were cleared, and clearance letter was provided.

Based on today's inspection, no deficiencies were cited in areas evaluated according to the Title 22 Division 12, Chapter 1 Ca. Code of Regulations. Exit interview and report was discussed with Director, Samantha Dionne. Signature of this form acknowledges receipt of these documents.

This report must be available in facility for public review. Notice of site visit was provided and shall remain posted for 30 days. Staff was advised for questions to contact the Regional Office, Mon- Fri, 8:00am-5:00pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/09/2024
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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