380504523-12-4-2023-05-CC-LGOZ-CY7UU3-20231204145249

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 380504523
Report Date: 12/04/2023
Date Signed: 12/04/2023 02:52:58 PM

Document Has Been Signed on 12/04/2023 02:52 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:	KATHERINE MICHIELS SCHOOL (PRE-K)		FACILITY NUMBER:	380504523
ADMINISTRATOR:	ANCHETA, YOLANDA		FACILITY TYPE:	850
ADDRESS:	1335 GUERRERO		TELEPHONE:	(415) 821-0130
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94110
CAPACITY:	36	CENSUS: 29	DATE:	12/04/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	08:55 AM
MET WITH:	Maria Luna		TIME COMPLETED:	11:45 AM

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 12/04/2023 at 8:55AM., Licensing Program Analyst (LPA), Luis J. Gomez met with Facility Administrator, Maria Luna. Purpose of inspection was explained and was for an Unannounced, Annual Random inspection. Facility is licensed to operate a preschool-age program. Present was the administrator and 4 staff supervising 29 children. Children present had been properly signed in. Staff’s criminal record clearances are on file. Preschool program utilizes one classroom and a shared Outdoor Play Area. Days and hours of operation are Monday- Friday 8:00am- 5:00pm. LPA inspected facility, indoors and outdoors for health and safety hazards. At 9:20AM., the following was observed: Classrooms were clean, orderly, with age-appropriate playthings available for the children. Floor and ground surfaces were clear of obstacles or hazards. Coat hangers are available or children's belongings. Accessible art supplies, books, and puzzles inspected were free of sharp corners or splinters. Classroom was equipped with child- sized tables and chairs for seated activities. Children’s bathroom was maintained clean, with fixtures in operating condition. Staff bathroom is located separate. Per administrator, napping supplies are washed weekly by families. Stackable napping cots inspected were made of a cleanable material. Facility had proper ventilation and lighting. Trash bins and outlets have been covered. Classroom had built-in smoke and functioning telephone, and fire extinguishers: 2A:10BC, which is fully charged. LPA reminded facility ensure testable carbon monoxide detector is available in the preschool program. Advisory Note: Technical Violation (LIC9102TV) was issued. Facility’s first aid kit was reviewed. (REFER TO 809C, FOR CONT.)

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2023

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 6

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: KATHERINE MICHIELS SCHOOL (PRE-K)	FACILITY NUMBER: 380504523
	VISIT DATE: 12/04/2023

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
26
27
28
29
30
31
32

(Page 2)
At 9:45AM., LPA inspected the outdoor play area. Area was completely enclosed, with playthings available for the children. Absorbent material had been installed around climbing structure. Structure inspected was properly anchored. Per licensee, water services are provided outside with labeled water bottles.

During inspection, LPA reviewed food preparation/storage room. Food items inspected were been properly stored. Area was observed clean and without trash or rubbish.

At 10:20AM LPA reviewed facility records including 3 children’s files and 4 personnel files. Staff’s files were reviewed and contained the: Notice of Employee Rights (LIC9052); Teacher Qualifications; and Personnel Record (LIC501).

LPA reminded administrator to ensure all staff’s updated proof of required immunization and the 'Mandated Reporter Training' Certifications (AB1207) are stored in facility records. Advisory Note: Technical Violation (LIC9102TV) was issued.

Children’s files were reviewed and contained the: Consent for Emergency Medical Treatment (LIC627), Identification and Emergency Information (LIC700); Personal Rights (LIC613A); Notification of Parent’s Rights (LIC995); Immunization Record; and ‘Written Medical Assessments’.

At 10:30AM., Based on Record Review and Interview, LPA confirmed required emergency disaster drill has not been conducted (or logged) in last 6 months.

Staff’s CPR/ 1^st Aid certification was current, expiring 2/2024.

LPA observed required posting in facility, including the: Facility License; Emergency Disaster Plan (LIC610); Earthquake Preparedness Checklist; Notification of Parent’s Rights (PUB394); and Child Passenger Safety Laws (PUB269). (REFER TO 809C, FOR CONT.)

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2023

LIC809 (FAS) - (06/04)

Page: 2 of 6

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: KATHERINE MICHIELS SCHOOL (PRE-K)	FACILITY NUMBER: 380504523
	VISIT DATE: 12/04/2023

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
26
27
28
29
30
31
32

(Page 3)
For IMS information see PIN 22-02CCP. 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/.

Assembly Bill (AB) 2370, chapter 676, statues 2018 requires all licensed child care centers (CCC’s) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and every five years after the date of the first test.

LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN21-21- CCP.

Licensee was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

Based on today's inspection, deficiencies were observed in the areas evaluated according to the Title 22 Division 12 Chap. 1 Ca. Code of Regulations, and cited on the 809D. Exit interview, appeal rights, plan of correction and report was discussed with Administrator, Maria Luna. Signature of this form acknowledges receipt of these documents.

This report must be made available in the facility for public review. Notice of site visit was given and must remain posted for 30 days. Licensee 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: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2023

LIC809 (FAS) - (06/04)

Page: 3 of 6

Document Has Been Signed on 12/04/2023 02:52 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: KATHERINE MICHIELS SCHOOL (PRE-K)	FACILITY NUMBER: 380504523
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/04/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101174(d)

(d) Disater drills shall be conducted every six months. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	At 10:30AM., Based on Record Review and Interview, LPA confirmed required emergency disaster drill has not been conducted (or logged) in last 6 months. This poses a potential health and safety risk to children in care.
	POC Due Date: 12/11/2023
	Plan of Correction
1 2 3 4	Facility will conducted and log required emegency disaster drill by the due date: 12/11/2023. Proof of corrdction will be subitted to the deparmtment via email.

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: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2023

LIC809 (FAS) - (06/04)

Page: 4 of 6