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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380504523
Report Date: 01/29/2020
Date Signed: 01/29/2020 12:10:59 PM

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:KATHERINE MICHIELS SCHOOL (PRE-K)FACILITY NUMBER:
380504523
ADMINISTRATOR:ZELLERBACH, LAURA ROSEFACILITY TYPE:
850
ADDRESS:1335 GUERREROTELEPHONE:
(415) 821-1434
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY:36CENSUS: 31DATE:
01/29/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Director, Yolanda AnchetaTIME COMPLETED:
10:45 AM
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Licensing Program Analyst, Luis J. Gomez met with Director, Yolanda Ancheta. Purpose of the inspection was explained and is for an unannounced annual inspection. The preschool program is a Reggio program inspired. Preschool program utilizes one classroom, which includes four different stations, outdoor play area #1 (garden, sand area, back deck ) and outdoor play area #2 (dirt mound area). Hours of operation are Monday- Friday 7:00am- 6:00pm. Present is the Director and three staff supervising 31 children. Facility is operating within capacity limits of the license. LPA Gomez inspected facility with director for health and safety hazards.

At 8:40am on January 29, 2020, LPA inspected: Classroom and Outdoor Play Area #1, #2. Classroom is clean, organized and have plenty of age appropriate toys, blocks, art supplies and books for the children. Classroom has a dramatic play area and art room. Several cubbies for children’s coats and belongings located in the classroom entry way. There are child size tables and chairs available for snack and activities. For napping, the children’s mats are available inside the hallway. Per director, blankets are taken home by the parents and washed weekly. Off-limits areas are properly barricaded with the uses of child safety gates. The children’s bathroom, located next to the classroom, is maintained clean with adequate supplies. Staff uses a separate restroom located upstairs. Accessible trash cans and outlets are covered. There is acceptable ventilation throughout. LPA Gomez observed the children’s medication is stored inaccessible to the day-care children. Children’s medication maintained in the facility. Detergents, cleaning supplies and toxins are stored inaccessible to day-care children. Classroom has a smoke detector, carbon monoxide detector and a fully charged fire extinguishers (2A:40BC). First aid kits and emergency disaster supplies are available in the classroom.

(Continuation on 809-C)

SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3
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: KATHERINE MICHIELS SCHOOL (PRE-K)
FACILITY NUMBER: 380504523
VISIT DATE: 01/29/2020
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(Page 2)

At 9:30am on January 29, 2020, LPA Gomez inspected outdoor play area #1 (garden area, sand area and back deck) and Outdoor play area #2 (dirt mound area). LPA observed the Outdoor play area is kept clean and free of debris and hazardous items. There is a facility garden, basketball area and covered art area with benches for the children. Play structure located in back yard area #1, is properly anchored. Sand has been placed under the play structure for additional padding. All tricycles and play equipment is in good repair.

During today’s inspection, five children and three personnel records were reviewed. All children files reviewed are complete. All teacher present have the required qualifications on file. Staff CPR/ 1st aid certification is current expiring: 08/2020. Emergency drills are conducted at the facility, with the last drill done on, 12/19/2019, properly logged. Required licensing information. Pre director, parents provide all daily snacks and meals. Fresh water is readily available for children with the use of water bottles.

Incidental Medical Services (IMS) was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding Americans with Disabilities Act (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: www.ada.gov/childqanda.htm.

During inspection,


· Director was reminded, as of September 1, 2016, all Staff and Volunteers must provide proof of immunization against pertussis, measles, and influenza, or qualifies for an exemption, pursuant to Health and Safety code 1596.7995 and 1597.662.
· Director was reminded about Mandated Reporter Training available on CCLD website. Training must be completed every 2 years. Training can be taken online at www.mandatedreporterca.com
(Continuation on page 3)
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2020
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: KATHERINE MICHIELS SCHOOL (PRE-K)
FACILITY NUMBER: 380504523
VISIT DATE: 01/29/2020
NARRATIVE
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(Page 3)
· Director was reminded about the Provider Information Notices (PINs) on CCLD website.
Licensee was advised for any additional questions to contact CCLD office, Monday to Friday, 8:00 am - 5:00 pm, (650) 266-8800 or 1 (844) 538-8766. Website: www.cdss.ca.gov

Director was provided effects of lead poisoning handout and parent immunization guide

Based on today's inspection, no deficiencies were observed in the areas evaluated according to the Title 22 Division 12 Ca. Code of Regulations. Exit interview was conducted with Yolanda Ancheta, and her signature of this form acknowledges receipt of these documents.



>This report and rights to comment and appeal were discussed with Director. This report must be available in the facility for public review. Notice of site inspection was posted.
Director 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: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2020
LIC809 (FAS) - (06/04)
Page: 3 of 3