380504052-4-13-2022-05-CC-HLEG-CDFRM8-20220413130818

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 380504052
Report Date: 04/13/2022
Date Signed: 04/13/2022 01:13:16 PM

Document Has Been Signed on 04/13/2022 01:13 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	PLAYMATES COOPERATIVE NURSERY SCHOOL		FACILITY NUMBER:	380504052
ADMINISTRATOR:	RONDEAU, JARROD		FACILITY TYPE:	850
ADDRESS:	2340 -42ND AVENUE		TELEPHONE:	(415) 681-2025
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94116
CAPACITY:	49	CENSUS: 37	DATE:	04/13/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Summer Al-Sardi		TIME COMPLETED:	01:15 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 13, 2022, Licensing Program Analysts (LPA), Leong and Van, conducted an unannounced annual random inspection with new director Summer Al-Sardi. LPAs explained the inspection's purpose to the director. LPAs requested the director to submit her qualifications and documents to the department. All staff at the facility have fingerprint clearance. LPAs observed three teachers, including the director and three co-op parents supervising thirty-seven children. The facility runs a co-op program. The hours of operation are Monday to Friday, 8:00 a.m. to 4:00 p.m. LPAs and the Director inspected the facility for potential health and safety hazards. In all classrooms, toys, furniture, and learning materials are age appropriate. The furniture and play structures appeared to be in good shape. The outdoor play structures are age-appropriate and well-kept. The facility has sand beneath all play structures to absorb accidental falls. The sandbox is inspected daily by the co-op parents. Per director, a company inspects the sandbox twice a year. The facility has no bodies of water on the premises. All cleaning products, poisons, and other hazardous chemicals have been kept out of children's reach. LPA reminded the director to keep hand sanitizer out of children reach. The facility is equipped with a smoke detector, a carbon monoxide detector, a fully charged fire extinguisher, a centralized smoke alarm, and working telephones. According to the director, there are no firearms or weapons in the facility. * See Page 2 for continuation*

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson Leong	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2022

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: PLAYMATES COOPERATIVE NURSERY SCHOOL	FACILITY NUMBER: 380504052
	VISIT DATE: 04/13/2022

NARRATIVE

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LPAs discussed with the director that the facility is required to post the required documents. (i.e., license, waivers, notification of parental rights, notification of personal rights, car seat law, emergency disaster plan, and daily activities).

LPAs reviewed the children's records during the inspection. All required forms were in the children’s file. The program uses sign in/out sheet, for authorized individuals to sign their children in and out. Children are required to bring their own lunch. The facility does provide snacks if the children forget their food.

A review of the facility's records revealed that the names, addresses, and phone numbers of each child's authorized representative are kept on file. A review of staff records revealed that one staff member has valid CPR and First Aid certifications.

According to the Director, the Center simulates fire and earthquake drills every month.

Licensee was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

***See Page 3 for continuation***

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson Leong	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2022

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: PLAYMATES COOPERATIVE NURSERY SCHOOL	FACILITY NUMBER: 380504052
	VISIT DATE: 04/13/2022

NARRATIVE

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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.

LPAs encouraged the Director to frequently visit the Licensing website at www.ccld.ca.gov for licensing regulations and new updates. Licensee can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

Incidental Medical Services (IMS) policy was discussed. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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)/ (800) 514-0383 (TTY) and link to the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

***See Page 4 for continuation***

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson Leong	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2022

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: PLAYMATES COOPERATIVE NURSERY SCHOOL	FACILITY NUMBER: 380504052
	VISIT DATE: 04/13/2022

NARRATIVE

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During the inspection, LPAs reminded the director to submit the following documents by 4/30/2022 to the department
1. LIC 500
2. LIC 308
3. LIC 610
4. Director’s qualifications
5. Staff meeting, discussing care and supervision, signatures of attendance required

No deficiencies were cited today

Both notice of site visit and annual inspection report will be emailed to the following email address, sumer@playmatespreschool.org, by the end of business day, 4/13/2022

A notice of site visit must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted, and report reviewed with director Summer Al-Sardi.

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson Leong	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2022

LIC809 (FAS) - (06/04)

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