380504354-7-20-2022-05-CC-LGOZ-CGHSKH-20220720135645

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 380504354
Report Date: 07/20/2022
Date Signed: 07/20/2022 01:57:05 PM

Document Has Been Signed on 07/20/2022 01:57 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:	SFUSD-ZAIDA T. RODRIGUEZ (EES) PRESCHOOL		FACILITY NUMBER:	380504354
ADMINISTRATOR:	MANCINA, JANE		FACILITY TYPE:	850
ADDRESS:	2950 MISSION STREET		TELEPHONE:	(415) 695-5842
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94110
CAPACITY:	60	CENSUS: 20	DATE:	07/20/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Lindsey Keener		TIME COMPLETED:	02:00 PM

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On 7/20/2022 at 9:05A.M., Licensing Program Analyst (LPA), Luis J. Gomez met with Principal, Lindsey Keener. Purpose of the inspection was explained and was for an unannounced; Annual/ Random inspection. Present was the Principal and five staff and (2 volunteers) supervising 20 children. All children present had been properly signed in. Preschool program operates in classrooms: #3, #4 and the Outdoor Play Yard. Hours of operation are Monday- Friday 7:30am- 5:30pm. Program operates year-around. Staff receive criminal record clearance through the school district. LPA inspected facility, indoors and outdoors, for health and safety hazards.

At 9:15A.M., LPA observed the following: Classroom inspected was clean, orderly, and with a variety of age-appropriate supplies available for the children. All floors and surfaces were free of obstructions.

At 9:20AM., Based on observations, LPA confirmed hazardous plant in classroom #3, accessible to day-care children. Plant was removed by staff during inspection; Advisory Note: Technical Violation (LIC9102TV) was issued.

Classroom had labeled cubbies for storage of each child’s belongings. Classroom had several child sized tables and chairs for snack and activities. Fixtures in children's bathrooms, were in proper operating condition. Bathroom had adequate supplies for children. The staff restroom is located separately. For napping services, stackable napping cots are stored in hallway. Per staff, napping supplies are washed by the families every week. LPA reminded facility to label each child’s designated napping cot.

At 9:30AM., Based on observations and interviews, LPA confirmed classroom #4 has been closed for painting and renovation. Site principal made classroom inaccessible during inspection.

Classroom had acceptable ventilation and lighting. Detergents, cleaning supplies and toxins were stored inaccessible to children. Classroom have functioning smoke detector, carbon monoxide detector and fire extinguishers (2A:10BC). First aid kit was fully stocked.

At 9:40A.M., LPA inspected the outdoor play area. Outdoor play area was enclosed with tall fencing and equipped with a shaded resting areas, and water fountain. Space was observed free of debris or hazardous plants or objects. Playthings inspected were in good repair and play structure had been properly anchored. LPA reminded facility to ensure all children containers are labeled. (REFER TO 809-C FOR CONT.)

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2022

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: SFUSD-ZAIDA T. RODRIGUEZ (EES) PRESCHOOL	FACILITY NUMBER: 380504354
	VISIT DATE: 07/20/2022

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(Page 2)
At 10:30AM LPA review facility records including 10 children’s files and four personnel files. Staff files reviewed and included: Proof of Qualifications (Permit), Notice of Employee Rights (LIC9052), and Declaration to Report Suspected Child Abuse (LIC9108). LPA reminded facility to ensure updated required proof of immunization are stored in the staff files. Staff had their updated mandated reporter certification training in the facility files.

Children’s files reviewed were complete and included: Consent for Medical Treatment (LIC627), Immunization Record, Identification of Emergency Information (LIC700), Health History, Personal Rights (LIC613A) and Notification of Parent’s Rights (LIC995).

Present staff members had their current CPR/ 1^st aid certification, which expires on: 2/2/2024.

Disaster drills are conducted every six months with the last drill done, 1/28/2022, properly logged.

Facility provides meals for day-care children. LPA observed required posting in facility, including: License, Parents Rights (PUB393), Emergency Disaster Plan (LIC610). LPA reminded facility to posted updated snack and lunch menu for families.

During inspection, LPA reviewed children’s medication.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manuel – Regulations Interpretations and Procedures for Child Care Centers Section 101173 and 101226. When an IMS is provided, an updated Plan of Operations that includes IMS must be submitted to the Department. Following information regarding ADA was provided: US Department of Justice (USDOJ) toll- free ADA information line at (800) 514- 0382 (TTY) and link to publications: Commonly asked questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm (REFER TO 809C FOR CONT.)

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2022

LIC809 (FAS) - (06/04)

Page: 2 of 5

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: SFUSD-ZAIDA T. RODRIGUEZ (EES) PRESCHOOL	FACILITY NUMBER: 380504354
	VISIT DATE: 07/20/2022

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(Page 3)
Based on today's inspection, deficiencies were observed in the areas evaluated according the Title 22 Division 12 Ca. Code of Regulations and cited on 809C. Exit interview and plan of correction was discussed with Principal, Lindsey Keener and her signature of this form acknowledges receipt of these documents.

This report and rights to comment were discussed. This report must be available in the facility for public review. Notice was given and must remain posted for 30 days. Facility was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2022

LIC809 (FAS) - (06/04)

Page: 3 of 5

Document Has Been Signed on 07/20/2022 01:57 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SFUSD-ZAIDA T. RODRIGUEZ (EES) PRESCHOOL	FACILITY NUMBER: 380504354
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/20/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101212(c)

121212(c): Reporting Requirement: The licensee shall notify the Department in writing of his/her intent prior to making any structural changes that reduce the total amount of indoor or outdoor activity space. Such structural changes shall include, but not be limited to, room additions. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observations and interviews, LPA confirmed classroom #4 has been closed for painting and renovation. The poses a potential health and safety risk to children in care.
	POC Due Date: 07/27/2022
	Plan of Correction
1 2 3 4	Facility will submit written plan to the Department by the due date: 7/27/2022. Plan will include: The closure and reopening date, as well as added security measures to ensure the area (classroom #4) remains inaccessible during operating hours.

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: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2022

LIC809 (FAS) - (06/04)

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