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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380504523
Report Date: 04/29/2022
Date Signed: 04/29/2022 01:56:12 PM


Document Has Been Signed on 04/29/2022 01:56 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:KATHERINE MICHIELS SCHOOL (PRE-K)FACILITY NUMBER:
380504523
ADMINISTRATOR:ZELLERBACH, LAURA ROSEFACILITY TYPE:
850
ADDRESS:1335 GUERREROTELEPHONE:
(415) 821-0130
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY:36CENSUS: 33DATE:
04/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Yolanda AnchetaTIME COMPLETED:
02:20 PM
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On 4/29/2022 at 10:00A.M., Licensing Program Analyst (LPA), Luis J. Gomez met with Director, Yolanda Ancheta. Purpose of the inspection was explained and was for an unannounced, Annual/ Random inspection. This a combination center with an infant program on-site. Present was Director and 4 staff supervising 33 children. All children present had been properly signed in. Preschool program utilizes one classroom space and three, shared, outdoor play areas. Hours of operation are Monday- Friday 8:00am- 6:00pm. Program operates year-round. LPA inspected facility, indoors and outdoors, with director for health and safety hazards.

At 10:10 A.M., the following was observed: Classroom inspected was clean, orderly with age-appropriate books and art supplies available for the children. Classroom had been divided in separate learning areas. Classroom was carpeted, with the ground surfaces free of any obstructions lead to the exits. Children’s furniture and playthings inspected were in proper repair. Classroom hallway had individual hangers for storage of children's belongings. Classroom had child size tables and several chairs for snack. For napping services, stackable napping cot and sleeping bags were stored in facility with each pertaining child’s name. Per director, children’s napping sheets are taken home weekly by families to be cleaned. Children’s bathroom was reviewed during inspection. Bathroom fixtures were in proper operating condition. Bathrooms had adequate supplies available for the children. Staff’s bathroom is located separate. Classroom was the proper temperature, with adequate ventilation and lighting. Cleaning detergents, supplies, spray bottles and all other toxins were made inaccessible. Outlets had been properly covered.

LPA reminded director to ensure trash bins have coverings installed.

Facility had functioning telephone service, smoke detector (Built-in), carbon monoxide detector and fully charged fire extinguisher (3A:40BC). First aid kit was review by LPA during inspection. (REFER TO 809C, FOR CONT.)

SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 04/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/29/2022
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 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: KATHERINE MICHIELS SCHOOL (PRE-K)
FACILITY NUMBER: 380504523
VISIT DATE: 04/29/2022
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(Page 2)
At 10:45A.M., LPA inspected facility’s outdoor play area, which includes the Facility Garden, Play Structure and Dirt Area. Outdoor spaces were completely enclosed with tall fencing. All outdoor playthings and items inspected were free of any sharp points. Play structure had been properly anchored, and the shaded resting area was accessible. Sand had been installed around play structure to absorb any potential falls. Per director, for water services, refillable water bottles are brought outside by staff. Per director, water bottles are refilled from a non-contained source.

At 11:10A.M., LPA review the facility records including ten children's files and five personnel files. Facility files reviewed included staff’s Criminal Record Statements (LIC508), Declaration to Report Suspected Child Abuse (LIC9108), Required Transcripts and Notice of Employee Rights (LIC9052).

All classroom personnel had their current mandated reporter training certification on file.

At 11:30A.M., Based on record review and interviews, LPA confirmed staff member, S3, missing proof of required immunization on file. During inspection, Advisory Note: Technical Assistance (LIC9102) was issued.

Children's files reviewed were complete and included the Health History (LIC702), Identification of Emergency Information (LIC700), Consent for Medical Treatment (LIC627), Notification of Parent’s Rights (LIC995) and Immunization Records.

Staff present had the Cardiopulmonary Resuscitation/ First Aid certification on file, which expires 11/2022. Facility is conducting emergency drills every six months, with the last drill done on, 11/16/2021, properly logged.

Per director, parent’s provide daily lunch and snack for children in care. LPA reminded director to ensure container brought from home are properly labelled with child’s name.

Required posting are posted and included the: Childcare License, Notification of Parents Rights (PUB393), and Updated Emergency Disaster Plan (LIC610). (REFER TO 809C, FOR CONT.)

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

DATE: 04/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2022
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: KATHERINE MICHIELS SCHOOL (PRE-K)
FACILITY NUMBER: 380504523
VISIT DATE: 04/29/2022
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(Page 3)

Per director, none of the preschool children in care required IMS services.

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 Child Care Center. A civil penalty of $100.00 minimum/ day up to $500.00 maximum per day/per person will be assessment if this regulation is violated.

Facility's 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

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



The 'Notice of Site Visit' was provided and must remain posted for 30 days.

This report and rights to comment were discussed. This report must be available in the facility for public review. For additional questions, facility was advised to contact the Community Care Licensing Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov

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

DATE: 04/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2022
LIC809 (FAS) - (06/04)
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