380500308-12-20-2019-05-CC-ACON-BK2PFV-20191220101724

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 380500308
Report Date: 12/20/2019
Date Signed: 12/20/2019 10:17:29 AM

COMPREHENSIVE INSPECTION

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:	HOLY FAMILY DAY HOME		FACILITY NUMBER:	380500308
ADMINISTRATOR:	MEYERS-THUM, KIM		FACILITY TYPE:	850
ADDRESS:	299 DOLORES STREET		TELEPHONE:	(415) 861-5361
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94103
CAPACITY:	150	CENSUS: 82	DATE:	12/20/2019
TYPE OF VISIT:	Annual/Required	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Tanya Bennett		TIME COMPLETED:	10:30 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 date 12/21/19 at 8:30, Licensing Program Analyst (LPA) April Cowan conducted an unannounced Annual Required Inspection and met with Center Director and Executive Center Director. LPA disclosed the purpose of the inspection and was granted entry into the facility by center Director. 82 children and 27 staff were present in the facility during this inspection. Facility is within ratio during this inspection. The facility consists of 8 classroom, a kitchen, and an outdoor play area. The classroom has heating and ventilation for safety and comfort. LPA and Director conducted an indoor and outdoor inspection of the facility. LPA observed the classrooms were clean and orderly with ample age appropriate toys. Director stated the toys are sanitized daily as required. LPA observed cubbies for each child labeled and orderly. Classroom is used for napping. LPA observed ample cots for licensed capacity to include individual bed linens. The bathroom observed were clean and in working order. >>> See next page

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April Cowan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2019

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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: HOLY FAMILY DAY HOME	FACILITY NUMBER: 380500308
	VISIT DATE: 12/20/2019

NARRATIVE

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A weekly menu was posted and is posted at least one week in advance. The refrigerator and pantry was observed with plenty of individually stored fruits and vegetables, food and milk that comply with nutritious value per regulations. The Center was observed with a fully charged 2A10BC fire extinguishers, carbon monoxide and smoke detector, and complete first aid kit. There is a medication cabinet that is locked with key. The outdoor play area observed with a securely anchored play structures and observed with cushioned material underneath to absorb a fall. LPA reviewed children's and staff's files today. Files were complete with all required documents.
LPA discussed with director Incidental Medical Services. Director states that they will mail in facility's policy next week. LPA discussed reporting procedures for unusual incidents with director.
An exit interview was conducted. A copy of this report and appeal rights were discussed and left with Director whose signature on this form confirms receipt of these documents.

>No deficiencies were issued today under Title 22 Division 12 of the Ca. Code of Regulations.

>This report and rights to comment and appeal were discussed with Licensee. This report must be available in the facility for public review. Notice of site visit was observed being posted.
Licensee was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.cdss.ca.gov

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April Cowan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2019

LIC809 (FAS) - (06/04)

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