380500308-4-5-2024-05-CC-MTSO-D42RP5-20240405131122

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 380500308
Report Date: 04/05/2024
Date Signed: 04/05/2024 01:11:30 PM

Document Has Been Signed on 04/05/2024 01:11 PM - 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:	HOLY FAMILY DAY HOME		FACILITY NUMBER:	380500308
ADMINISTRATOR:	POOYAN, SETAREH		FACILITY TYPE:	850
ADDRESS:	299 DOLORES STREET		TELEPHONE:	(415) 861-5361
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94103
CAPACITY:	150	CENSUS: 49	DATE:	04/05/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:37 AM
MET WITH:	Setareh Pooyan		TIME COMPLETED:	01:25 PM

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 April 05, 2024, at approximately 8.30am, Licensing Program Analyst (LPA) Tso met with Director Setareh Pooyan for an unannounced required visit to the child care center listed above. LPA explained the reason for the inspection and was granted access to the facility. This is a combination Center with Infants, toddler and Preschool programs operating in the same building under two licenses. Present in the center included 12 staff members and 45 preschool-aged children. The center is operating within its capacity and in accordance with the required ratio of staff to children. Hours of operation are Monday- Friday, 7:00 am- 5:00 pm. LPA assessed the Center for Health and Safety Hazards with the Director. Per Director, there are no changes to the existing physical plant. The facility maintains a record of sign-in/out for children. The children's classroom environment appeared clean and organized, with appropriate heating, lighting, and ventilation. The Center also provided age-appropriate toys, furnishings, changing tables, and equipment. LPA did not observe any pools, spas, or other bodies of water. According to the Director, no firearms or weapons are present at the Center, and all cleaning materials and potentially hazardous objects are kept out of reach of children. Personnel restrooms are separate from children, and all solid waste storage containers have tightly fitted lids. The Center also maintains multiple carbon monoxide detectors, centralized smoke alarm, fully charged fire extinguisher, and First Aid kit. Designated cubbies are available for children to store their belongings. There is sufficient sleeping equipment and cots for each child, and all mats and bedding are kept in the appropriate location. LPA also observed that the food preparation site is clean, organized, and inaccessible to children. Preschool program shares outdoor space with infant license. Directors are aware preschool and infant children are not to use shared outdoor playgrounds at the same time. LPA observed outdoor space to have separated areas for each program. There is a chicken coop in outdoor area that is kept separate from children's play areas. LPA observed chicken coop to be properly maintained and cleaned. Water is made available to children indoors and outdoors with facility's water pitcher and/or children's individually labeled water bottles. (Continued on page 2...)

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8867
LICENSING EVALUATOR NAME: Man Tso	TELEPHONE: (650) 379-9021
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2024

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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Document Has Been Signed on 04/05/2024 01:11 PM - It Cannot Be Edited

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: HOLY FAMILY DAY HOME	FACILITY NUMBER: 380500308
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/05/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

101700(b)

Written Directives for Lead Testing

(b) All licensed Child Care Centers operating in buildings constructed before January 1, 2010, shall test their water for lead pursuant to these written directives. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based upon record review, the facility did not test for lead until 4/10 &11/2023, which poses / posed a potential health, safety, or personal rights risk to the persons in care.
	POC Due Date: 04/19/2024
	Plan of Correction
1 2 3 4	The facility should have water outlets tested for lead contamination by the due date: 04/19/2024. The water was tested on 4/10&11/2023. The deficiency was cleared on today’s visit.

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: Garfield Leung	TELEPHONE: (650) 266-8867
LICENSING EVALUATOR NAME: Man Tso	TELEPHONE: (650) 379-9021
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2024

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: HOLY FAMILY DAY HOME	FACILITY NUMBER: 380500308
	VISIT DATE: 04/05/2024

NARRATIVE

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LPA checked the personnel and children's records at the facility. A sample of children's files was found to contain comprehensive information such as medical assessments, needs, services, feeding plans, and signed admission agreements. The staff files were also well-organized and thorough with Mandated Reporter Training Certificate (AB1207) valid until 11/24. Multiple staff members were observed to have valid CPR/First Aid cards and vaccine proofs for Measles, Pertussis, and Influenza in their files. Additionally, the facility had posted the required documents, including the license, menus, waivers, Notification of Parental Rights, Notification of Personal Rights, Car Seat Law, and Emergency Disaster Plan. The Director stated that fire and earthquake drills are conducted monthly, with the most recent fire drill being held in March 2024.

LPA discussed the safe sleep regulations with the Director and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed the Director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

LPA reminded the Director that as of September 1, 2016. A person may not be employed or volunteer at a childcare facility unless he or she has been immunized against influenza, pertussis, and measles.

The 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/.

The Director 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.
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SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8867
LICENSING EVALUATOR NAME: Man Tso	TELEPHONE: (650) 379-9021
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2024

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: HOLY FAMILY DAY HOME	FACILITY NUMBER: 380500308
	VISIT DATE: 04/05/2024

NARRATIVE

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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). The facility conducted their water test for lead contamination on April 10 &11, 2023, which did not complete testing prior to their deadline. Type B deficiency citation was issued. (Please refer to LIC809D).

LPA verified that the lead testing result indicated by the laboratory report that leads in the drinking water levels were below the current California Action limit of 5.5ppb. Hence, the deficiency citation is cleared on today’s visit.

The Director was informed about Mandated Reporter training available on the CCLD website. In addition to AB1207 training required to be completed every two years by all staff hired a one-time General Training is also required. Training can be taken online at www.mandaterreporterca.com. Also, the Director was reminded of Pesticide training. Information on the DPR website at: www.cdpr.ca.gov/shoolipm/childcare

The Director 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.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

Please refer to LIC 809D for today’s citation. A copy of today’s report and the facility’s appeal rights were discussed and given to the Director. The Notice of Site Visit was given to the Director and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Exit interview conducted and report was reviewed with the Director, Setareh Pooyan.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8867
LICENSING EVALUATOR NAME: Man Tso	TELEPHONE: (650) 379-9021
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2024

LIC809 (FAS) - (06/04)

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