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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005487
Report Date: 11/22/2021
Date Signed: 11/22/2021 01:33:24 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:GOLDEN POPPY PRESCHOOL & INFANT CENTERFACILITY NUMBER:
214005487
ADMINISTRATOR:BROWN, KELLYFACILITY TYPE:
850
ADDRESS:50 EL CAMINO DRTELEPHONE:
(415) 924-2828
CITY:CORTE MADERASTATE: CAZIP CODE:
94925
CAPACITY:109CENSUS: 24DATE:
11/22/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Director, Kelly BrownTIME COMPLETED:
01:40 PM
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Licensing Program Analyst (LPA) Kassandra Medrano made an unannounced case management visit in response to request from the director. The facility has newly renovated outdoor play area with new equipment and landscape. The outside play area is completely fenced, clean and in good repair. The playground is free of hazardous materials. Play equipment is age appropriate, and safe. Climbing structure is secure, free of any loose parts and has sufficient amounts cushioning on the floor to prevent any fall injuries. There are no bodies of water. Drinking water is accessible by water bottles. Playground meets Title 22 regulations for outdoor activity space.

No deficiencies are cited today. The copy of this report is reviewed and provided to the director. Notice of site visit is posted and shall remain posted for next 30 days.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Kassandra MedranoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2021
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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