380504560-5-9-2023-05-CC-LGOZ-CRNRML-20230509130854

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 380504560
Report Date: 05/09/2023
Date Signed: 05/09/2023 01:09:07 PM

Document Has Been Signed on 05/09/2023 01:09 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	SFUSD-JUNIPERO SERRA EARLY EDUCATION SCHOOL (PS)		FACILITY NUMBER:	380504560
ADMINISTRATOR:	ARI, VANI S.		FACILITY TYPE:	850
ADDRESS:	155 APPLETON STREET		TELEPHONE:	(415) 920-5138
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94110
CAPACITY:	67	CENSUS: 37	DATE:	05/09/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:55 AM
MET WITH:	Danielle Loughridge		TIME COMPLETED:	01:15 PM

NARRATIVE

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On 5/9/2023 at 8:55AM., Licensing Program Analyst (LPA), Luis J. Gomez met with Administrative Assistant, Alma Portillo. Purpose of the inspection was explained and was for an unannounced Annual/ Random inspection. Principal, Danielle Loughridge arrived during inspection. This preschool program operates at the Junipero Serra Annex EES. Present was the principal and 9 staff supervising 37 children. Preschool program operates in classrooms: #3, #4, #5 and utilizes one, shared, outdoor play yard. Outdoor space waiver was observed during inspection. Days and hours of operation are Monday- Friday 7:30am- 5:30pm. Children present had been properly signed-in. Personnel receive criminal record clearances through school district. LPA inspected facility, indoors and outdoors, for health and safety hazards.

At 9:10AM., LPA observed the following: Classrooms were clean and orderly, with a variety of age-appropriate books, blocks and art supplies for the children. Floors and ground surfaces were free of obstructions. Classrooms had cubbies for storage of child’s belongings. Playthings were free of sharp edges or splinters. Classrooms had child sized tables and chairs for snack and seated activities. Fixtures in children's bathrooms (5 toilets, 5 sinks) were in operating condition, with adequate supplies for hand washing. Staff bathroom is located separately. For napping services, program provides quiet rest time with napping mat assigned to each child. Per staff, napping supplies are taken home weekly to be washed. Classrooms had acceptable ventilation and lighting. Detergents, cleaning supplies and toxins are stored inaccessible to children. Classrooms have built-in smoke detector, functioning carbon monoxide detector, and fire extinguishers (2A:10BC) located in each room. First aid kits reviewed were fully stocked.

At 9:55AM., LPA inspected the outdoor play area. Outdoor play area was completely enclosed. Outdoor space was observed free of debris or hazardous plants. Playthings inspected were in good repair and play structure is properly anchored. Rubber padding has been installed for added safety.

For accessible water services, fountains are available indoors and outdoors. Per staff, lead testing on fixtures was conducted in 2022. (REFER TO 809C, FOR CONT.)

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023

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 05/09/2023 01:09 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SFUSD-JUNIPERO SERRA EARLY EDUCATION SCHOOL (PS)	FACILITY NUMBER: 380504560
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/09/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.7995(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	At 10:30AM., Based on record review, LPA confirmed staff's proof of required immunization missing from facility files. This poses a potential health and safety risk to children in care.
	POC Due Date: 05/19/2023
	Plan of Correction
1 2 3 4	Facility will ensure all staff's immunization are stored in personnel files by the due date: 5/19/2023. Proof of correction will be submitted to the department 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: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023

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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SFUSD-JUNIPERO SERRA EARLY EDUCATION SCHOOL (PS)	FACILITY NUMBER: 380504560
	VISIT DATE: 05/09/2023

NARRATIVE

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(Page 2)
At 10:25AM, LPA review facility records including five children’s files and six personnel files. Staff files reviewed and included: Proof of Education, Notice of Employee Rights (LIC9052), Criminal Record Statement (LIC508), Declaration to Report Suspected Child Abuse (LIC9108), and Mandated Reporter Training Certification (AB1207).

At 10:30AM., Based on record review, LPA confirmed staff's proof of required immunization missing from facility files.

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

Lead Teacher has their current CPR/ 1^st aid certification on file, which expires on 9/2023.
Emergency disaster drills are conducted every six months with the last drill done on, 4/20/2023, and properly logged.

Facility provides all daily snack and meals. Food preparation area/ kitchen was reviewed during inspected. Storage cabinets and refrigerator are clean and in proper use. Food items inspected were current, with area was free of rubbish are trash.

LPA observed required posting in facility, including License, Notification of Parent’s Rights (PUB393), Emergency Disaster Plan (LIC610), Menus, and Outdoor Space Waiver. LPA reminded principal to post the required passenger safety laws form (PUB269).

During inspection, LPA reviewed children’s medication stored in classrooms. Incidental Medical Services (IMS) plans were stored in children’s files.

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: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023

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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SFUSD-JUNIPERO SERRA EARLY EDUCATION SCHOOL (PS)	FACILITY NUMBER: 380504560
	VISIT DATE: 05/09/2023

NARRATIVE

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(Page 3)
Based on today's inspection, deficiencies were observed in the areas evaluated according to the Title 22 Division 12 Ca. Code of Regulations and cited on 809D. Exit interview, appeal rights, and plan of correction was discussed with Principal, Danelle Loughridge, and 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: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023

LIC809 (FAS) - (06/04)

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