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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380504369
Report Date: 10/24/2022
Date Signed: 10/24/2022 02:36:45 PM


Document Has Been Signed on 10/24/2022 02:36 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:ST. NICHOLAS DAY CARE AND PRESCHOOLFACILITY NUMBER:
380504369
ADMINISTRATOR:TUWAI, KATHYFACILITY TYPE:
850
ADDRESS:5200 DIAMOND HEIGHTS BLVD.TELEPHONE:
(415) 550-1536
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94131
CAPACITY:70CENSUS: 42DATE:
10/24/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Kathy TuwaiTIME COMPLETED:
02:45 PM
NARRATIVE
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On October 24, 2022 at approximately 8:15am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, annual inspection. LPA met with director, Kathy Tuwai, and explained the purpose of the inspection.

Facility operates on lower level of St. Nicholas Orthodox Church. Hours of operation are Monday to Friday 7:45am to 5:30pm.

Facility is a combination center of a preschool and infant program. Under preschool license, there are 3 classrooms: Honey Bees, Sunshine, and Rainbow. Under preschool license, present during LPA's visit included 9 staff members (including director) with 42 enrolled children. Facility is operating within capacity limits and ratio during LPA's visit.

With director, LPA inspected the entire facility for health and safety hazards. Preschool classrooms are separated by age groups. Honey Bee classroom is for children from 2 to 3 years old. Sunshine classroom is for children from 3 to 4 years old. Rainbow classroom is for children from 4 to 5 years old.

LPA observed each classroom to have areas for children to nap, eat and play. Storage for children's belongings are located inside each classroom, labeled with each child's individual names. LPA observed each classroom to have a working carbon monoxide detector, fully charged fire extinguisher and fully stocked first aid kits. Classrooms are equipped with age appropriate toys and materials for children in care. Cots are utilized for napping children. Per director, cots and sheets and cleaned and sanitized daily.



LPA observed poisons, cleaning solutions and hazardous materials to be stored inaccessible to children in off limit classroom closets or on facility's high shelves. Classrooms are equipped with appropriate furniture, toys and materials for children.

Facility provides a food service that includes breakfast, lunch and snack. LPA observed kitchen and food prep areas to be clean and orderly. All food is stored and prepared properly to avoid contamination.
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SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina QuimboTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 10/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/24/2022
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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Document Has Been Signed on 10/24/2022 02:36 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: ST. NICHOLAS DAY CARE AND PRESCHOOL
FACILITY NUMBER: 380504369

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/24/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101239(n)
Fixtures, Furniture, Equipment and Supplies
(n) Furniture and equipment shall be maintained in good condition, free of sharp, loose or pointed parts.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the facility did not comply with the section cited above in having multiple, accessible broken/cracked toilet tanks in children's bathroom, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/24/2022
Plan of Correction
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Director stated new toilet tanks are available for installation. Director to provide proof of installation to LPA no later than 11/24/2022 by 5:00pm.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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 InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina QuimboTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 10/24/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/24/2022
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: ST. NICHOLAS DAY CARE AND PRESCHOOL
FACILITY NUMBER: 380504369
VISIT DATE: 10/24/2022
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LPA observed bathrooms in Sunshine and Rainbow classrooms to be in proper working condition. Bathrooms are equipped with appropriate sanitation materials. Sinks do not provide water that is warmer than 120 degrees Fahrenheit.

LPA observed bathroom in Honey Bees classroom to also be in proper working condition. Honey Bees bathroom is equipped with 3 children's toilets and 2 children's sinks. LPA observed 2 of the 3 children's toilets to be broken and/or cracked on the top of the tank. LPA observed top of toilet tanks to be taped and covered in plastic bags to avoid tanks from breaking. LPA observed tape and plastic bags utilized to be coming off tanks, making sharp edges of toilet tanks accessible to children. Per director, new toilet tanks are available to install, however, facility has not installed new equipment. LPA discussed the potential health and safety hazards with director of exposing a broken and/or cracked toilet tank to children in care.

LPA observed high window located in Sunshine classroom to also be covered by tape. Director stated window stays open and tape keeps high window closed. LPA observed tape on window to be partially coming off window. LPA discussed the potential health and safety hazards with director of tape fully coming off high window, falling open overhead.

Water is made available throughout the facility through filtered water stations. Preschool program shares "outdoor area" / atrium with infant program on a rotation schedule. Director is aware infant and preschool children are not to use atrium at same time. LPA observed atrium to have sufficient toys and materials that were in good working condition. Area includes a climbing structure that was observed to have resilient padding underneath. Poles located in atrium are appropriately padded. LPA observed drain located in atrium to be properly covered and made inaccessible to children.

Facility has license documentation and information properly posted and available for review. Emergency drills are conducted at least once every six months and are properly logged and documented. Last emergency disaster drill was conducted 07/13/2022.

LPA reviewed facility records that included 10 children's records and 10 staff records. LPA observed children's records to be complete and properly maintained. There was a record of emergency identification information on file for each enrolled infant. Multiple staff members in classroom have a CPR/First Aid certification that is current. Director's CPR/First Aid is current and will expire 01/2022.
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SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina QuimboTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2022
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: ST. NICHOLAS DAY CARE AND PRESCHOOL
FACILITY NUMBER: 380504369
VISIT DATE: 10/24/2022
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Director 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 completion certificate on file. LPA encourages the director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates.

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.

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.

LPA discussed the safe sleep regulations with 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 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.

Incidental Medical Services (IMS) policy was discussed. Program is providing IMS at this time. 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 publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Facility was cited a Type B citation for a broken and/or cracked toilet tank that is made accessible to children in care. See 809D for details.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements will result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with director, Kathy Tuwai.
SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina QuimboTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2022
LIC809 (FAS) - (06/04)
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