380500254-3-28-2024-05-CC-JTSE-D3SP7A-20240328110336

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 380500254
Report Date: 03/28/2024
Date Signed: 03/28/2024 11:03:54 AM

Document Has Been Signed on 03/28/2024 11:03 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:	HAIGHT ASHBURY COOPERATIVE NURSERY SCHOOL		FACILITY NUMBER:	380500254
ADMINISTRATOR:	DRAKE, COCOA		FACILITY TYPE:	850
ADDRESS:	1180 STANYAN STREET		TELEPHONE:	(415) 661-9204
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94117
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 12	CENSUS: 8	DATE:	03/28/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:35 AM
MET WITH:	Director, Cocoa Drake		TIME COMPLETED:	11:20 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 3/28/2024, at approximately 8:35AM, Licensing Program Analyst (LPA) Jonathan Tse conducted an unannounced annual visit at the facility. LPA met with the Director, Cocoa Drake (D1). LPA explained the purpose of the visit. Present during the visit was D1, two parent volunteers and eight preschool age children. The facility is in compliance with staffing and ratio requirements on this day. The facility is a parent-cooperative program. The facility’s operating hours are from 9:30AM to 12:30PM. LPA inspected the facility for any health or safety hazards. LPA observed the facility to be in clean and orderly condition. There are age-appropriate toys and learning materials in the classroom. LPA observed manipulatives and books to be available for children in care. There are cubbies available for each child enrolled in the facility. LPA observed the bathroom sink and toilets to be operational. There is a carbon monoxide detector present in the classroom. There is a fully charged 2A10BC fire extinguisher stored in the kitchen. There is functioning phone service in the facility. There are first aid supplies present in the classroom. Furniture is age-appropriate and has rounded edges. Children bring lunch and water bottles from home. Water bottles are refilled at a non-contaminating fixture in the facility. LPA observed the outdoor play area to be free of debris and other loose articles. The outdoor play area is a public space, Grattan Playground. The facility utilizes the middle play area for outdoor play and music activities. Entrances to the Upper Yard (tennis courts) and Lower Yard (play structures and swings) are secured by bungee cables to be inaccessible to children in care. LPA observed the cables to be pulled tight and secured to fences so that children cannot not open the gates by themselves. There is resilient padding in the form of sand for the play structures. There is shade available with the use of a tarp. Continued on Page Two

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: HAIGHT ASHBURY COOPERATIVE NURSERY SCHOOL	FACILITY NUMBER: 380500254
	VISIT DATE: 03/28/2024

NARRATIVE

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LPA reviewed personnel records, six children’s records, and facility records. LPA observed D1’s First Aid/CPR and Mandated Reporter trainings to expire on 2/2025. Immunizations are available for review. LPA observed all children’s records to be complete. LPA discussed required postings with D1. The facility license is posted in a visible and accessible area. LPA observed a sign-in/out sheet to be present in the entryway of the facility. LPA discussed sign-in/out policy with D1. Per D1, the last emergency drill was conducted in 11/2023. LPA advised that D1 maintain the emergency drill log in an accessible portion of the facility for review.

Based on record review of the facility’s lead sampling, LPA observed that the facility did not conduct lead testing by the deadline of 1/1/2023. The facility conducted lead testing on 4/27/2023, past the deadline. There were no exceedances of lead above 5.4 parts per billion (ppb) in the tested fixtures. LPA advised that lead testing results shall be posted and available for review.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at
www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a
maximum of 30 days per person will be assessed if this regulation is violated.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).
Continued on Page Three

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: HAIGHT ASHBURY COOPERATIVE NURSERY SCHOOL	FACILITY NUMBER: 380500254
	VISIT DATE: 03/28/2024

NARRATIVE

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LPA referred facility representative to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care
Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

See LIC809-D for deficiency cited and cleared today regarding lead water testing. See LIC9102-TV for technical violation issued today regarding documentation of emergency drills. Appeal rights were provided and explained to D1. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the facility representative, Cocoa Drake.

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/28/2024 11:03 AM - It Cannot Be Edited

Created By: Jonathan Tse On 03/28/2024 at 10:44 AM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: HAIGHT ASHBURY COOPERATIVE NURSERY SCHOOL	FACILITY NUMBER: 380500254
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/28/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.16(a)(1)

Lead Testing

(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above by testing for lead on 4/27/2023, past the deadline of 1/1/2023, which posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/26/2024
	Plan of Correction
1 2 3 4	Lead testing was conducted and there were no exceedances of lead in the facility's fixtures. This deficiency shall be cited and cleared on the day of the visit, 3/28/2024.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Ali Zebila

LICENSING EVALUATOR NAME:

Jonathan Tse

LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024

LIC809 (FAS) - (06/04)

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