380504057-4-20-2022-05-CC-BVAN-CDNREY-20220420125819

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 380504057
Report Date: 04/20/2022
Date Signed: 04/20/2022 12:59:21 PM

Document Has Been Signed on 04/20/2022 12:59 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:	ROCKY MOUNTAIN PARTICIPATION NURSERY SCHOOL		FACILITY NUMBER:	380504057
ADMINISTRATOR:	WILDMAN, KAUSAR		FACILITY TYPE:	850
ADDRESS:	2475 - 15TH STREET		TELEPHONE:	(415) 552-2929
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94114
CAPACITY:	20	CENSUS: 15	DATE:	04/20/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Kausar Wildman		TIME COMPLETED:	01:00 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 20, 2022, Licensing Program Analyst (LPA) Van met with Director Kausar Wildman for an unannounced annual random inspection. The purpose of the inspection was explained and granted entry to the facility by the Director. The facility is a Preschool Cooperative. The facility operates in a large classroom and a small quiet room. Present today are 15 children supervised by three staff and two co-op parents. The facility complies with the staff-children ratios today. The days and operations hours are Monday - Friday from 9:00 am to 2:45 pm. LPA toured and inspected the physical plant for any health and safety hazards. The facility has a sign-in /out for parents or authorized representatives. LPA observed the sign/in & out had complete parents' signatures. LPA observed that each child has their cubbies available with their name labeled. The facility is in good repair and has proper temperature and ventilation. Classrooms have age-appropriate toys and learning materials. Furniture appears steady and in good repair. The facility has multiple carbon monoxide detectors, a smoke alarm, fully charged fire extinguishers, and a working telephone. Director states that the facility currently does not have any children with any medication. However, Director understood that medications required appropriate labeling and storing out of reach of children. First aid supplies are fully stocked and available for children's usage. All cleaning solutions, poisons, and other dangerous chemicals are stored in an area inaccessible to children. The facility has two toilets and a sink for children, and the staff has a separate bathroom. All toilets and handwashing sink are in good working condition with proper sanitation. The outdoor play area is completely fenced, clean, and in good repair. Outdoor play structures are age-appropriate, in good condition, and free of loose parts. Climbing structures are securely anchored, and there are sands underneath all play structures to absorb accidental falls. Director stated sands areas are raked and inspected daily prior to children's play. LPA observed no bodies of water on the premises.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2022

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: ROCKY MOUNTAIN PARTICIPATION NURSERY SCHOOL	FACILITY NUMBER: 380504057
	VISIT DATE: 04/20/2022

NARRATIVE

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The facility had posted the required forms. (i.e., License, Notification of Parent's Rights, Notification of Personal Rights, Emergency Disaster Plan, and Daily activities). Per the Director, the Center provides one snack for children. The snack menu is observed posted. The food preparation area is adequately equipped, clean, free of hazards, and inaccessible to children. Children brought water bottles from home, but the facility also has water pitchers readily available for children indoors and outdoors. All storage containers for solid waste within the Center have a proper tight-fitting cover.
Ten random children's records and personnel records were reviewed during the inspection. Records review showed the facility has records of each child's authorized representative's names, addresses, and telephone numbers. In addition, each child's immunization record, medical assessment, and admission agreement can be located in each child's file. Staff records indicate that all staff or other individuals who require caregiver background checks have received criminal records and child abuse index clearances or exemptions. Multiple staff members have a record of valid CPR. All staff maintained immunization records. LPA reviewed the educational qualification of the Director and staff, and all staff had the required ECE units. The Director stated that the Center conducts fire and earthquakes monthly, and the last drill was conducted on 4/6/2022.
The 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
The Director 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.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2022

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: ROCKY MOUNTAIN PARTICIPATION NURSERY SCHOOL	FACILITY NUMBER: 380504057
	VISIT DATE: 04/20/2022

NARRATIVE

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The Director was informed about Mandated Reporter training available on the CCLD website. In addition to AB1207 training required to complete every two years by the Licensee and 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 Pesticides training. Information on the DPR website at: www.cdpr.ca.gov/shoolipm/childcare
LPA encouraged the Director to frequently visit the Licensing website at www.ccld.ca.gov for licensing regulations and new updates. Director can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

During the inspection, LPA requested an up-to-date Emergency Disaster Plan (LIC 610), Personnel Report (LIC 500), the Designation of Administrative Responsibility (LIC 308), and LIC 309 Administration Organization.

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.
No deficiencies are cited today. An exit interview was conducted, and the report was reviewed with the Director, Kausar Wildman. Today's report, April 20, 2022, and notice of site visit will be sent to the Director by email by the close of business on April 20, 2022. Confirmation of receipt is required. LPA informed the Director that the site visit notice must be posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2022

LIC809 (FAS) - (06/04)

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