380504057-12-2-2024-05-CC-JGIL-DBKVCA-20241202151850

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 380504057
Report Date: 12/02/2024
Date Signed: 12/02/2024 03:19:03 PM

Document Has Been Signed on 12/02/2024 03:19 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:	ROCKY MOUNTAIN PARTICIPATION NURSERY SCHOOL		FACILITY NUMBER:	380504057
ADMINISTRATOR/ DIRECTOR:	WILDMAN, KAUSAR		FACILITY TYPE:	850
ADDRESS:	2475 - 15TH STREET		TELEPHONE:	(415) 552-2929
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94114
CAPACITY: 20	TOTAL ENROLLED CHILDREN: 20	CENSUS: 13	DATE:	12/02/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:15 PM
MET WITH:	Kausar Wildman		TIME VISIT/ INSPECTION COMPLETED:	03:40 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 December 2nd, 2024 at approximately 1:15 PM, Licensing Program Analyst (LPA) Janet Gil conducted an unannounced, annual inspection. LPA met with lead teacher, Kelly Gleason, and explained the purpose of the inspection. At the time of arrival for the inspection, center director was away for a appointment. At approximately 2:15 PM. Director Kausar Wildman arrived at the facility. Hours of operation are Monday to Friday 8:45 AM to 2:45 PM. Facility has a morning group from 8:45 AM to 12:00 PM and an afternoon group from 12:00 PM to 2:45 PM. Present during inspection included 13 children with 3 staff members (including director) and 4 parent staff. Facility is operating within capacity requirements and ratios at time of LPA's inspection. The facility is a Preschool Cooperative. The facility operates in a large classroom and a small quiet room. LPA and director inspected facility, indoors and outdoors, for health and safety hazards. LPA observed classroom to be clean, equipped with age appropriate toys, materials, and furniture. LPA observed electrical outlets to be made inaccessible with outlet covers and furniture. LPA also observed covered trash cans in the classroom. Storage for children's belongings are located inside the classroom, labeled with each child's individual names. Per teacher staff, program is a half day and there is no designated nap time to children in care. LPA observed facility has a carbon monoxide detector in the classroom. A fully stocked and accessible first aid kit is located in the children's bathroom. Facility has a fire extinguisher located near the entrance of the facility. All poisons, cleaning solutions and hazardous materials are stored inaccessible to children on facility's high shelves. LPA observed children's bathrooms to be clean and in proper working condition. Facility provide snack as a food service only. Menus are posted near the kitchen entrance. Parents and authorized representatives provide food for enrolled children that is packaged and stored inside the classroom. Lunches are labeled with each child's individual names. Water is available to children indoors and outdoors with children's water bottles and/or pitchers. Continue on Page 2...

Garfield Leung	TELEPHONE: (650) 266-8800
Janet Gil	TELEPHONE: 650-266-8800
	DATE: 12/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2024

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: ROCKY MOUNTAIN PARTICIPATION NURSERY SCHOOL	FACILITY NUMBER: 380504057
	VISIT DATE: 12/02/2024

NARRATIVE

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Outdoor area is fully enclosed and has age appropriate toys and materials that were in working condition. LPA observed play structure to contain sand underneath. Per director, all parent staff rake the outside area each morning and one parent does a walk around to ensure outdoor area is clean and safe to children in care.

Children are signed in and out of facility through a paper system by the front entrance. All children were signed in correctly during LPA's visit. Facility has license documentation and information properly posted and available for review in main entrance of facility. Preschool program conducts drills at least once every six months. Last conducted disaster drill was on 11/12/2024.

LPA reviewed 6 children's files and 3 staff files. Children's files were complete with a record of emergency identification information on file. Staff files were also complete. All staff have a valid CPR/First Aid certificates. All staff also have proof of required immunization and Mandated Reporter Training Certificates that were made available for review.

Facility was informed that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.

Director is aware that all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. LPA observed the completed certificate on file. LPA encourages the director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates.

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.

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/inspection-process.

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SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Janet Gil	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2024

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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: ROCKY MOUNTAIN PARTICIPATION NURSERY SCHOOL	FACILITY NUMBER: 380504057
	VISIT DATE: 12/02/2024

NARRATIVE

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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/.

CCC DID NOT COMPLETE TESTING PRIOR TO THEIR DEADLINE

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

Facility failed to test for lead water before January 1st, 2023. Type B deficiency is being issued on this day in accordance with the California Code of Regulations, Title 22, see LIC 809D.

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

Exit interview conducted and report was reviewed with director, Kausar Wildman.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Janet Gil	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2024

LIC809 (FAS) - (06/04)

Page: 3 of 4

Document Has Been Signed on 12/02/2024 03:19 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: ROCKY MOUNTAIN PARTICIPATION NURSERY SCHOOL	FACILITY NUMBER: 380504057
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/02/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

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 interview and record review, the licensee did not comply with the section cited above in testing for lead contamination levels at the facility before January 1st, 2023 which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/02/2025
	Plan of Correction
1 2 3 4	LPA will email correct information on Lead Testing for Child Care Centers. Facility plans to have State Tester come in as soon as avalible.

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.

Garfield Leung	TELEPHONE: (650) 266-8800
Janet Gil	TELEPHONE: 650-266-8800
	DATE: 12/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2024

LIC809 (FAS) - (06/04)

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