380504742-4-5-2024-05-CC-JTSE-D42RXG-20240405132444

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 380504742
Report Date: 04/05/2024
Date Signed: 04/05/2024 01:25:08 PM

Document Has Been Signed on 04/05/2024 01:25 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:	CCFC-EDDY		FACILITY NUMBER:	380504742
ADMINISTRATOR:	DAVIDSON, FONDA		FACILITY TYPE:	850
ADDRESS:	1672 EDDY STREET		TELEPHONE:	(415) 567-9126
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94115
CAPACITY:	50	CENSUS: 14	DATE:	04/05/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:10 AM
MET WITH:	Site Supervisor, Estrellita "Ester" Guirre		TIME COMPLETED:	01:40 PM

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 4/5/2024, at approximately 11:10AM, Licensing Program Analyst (LPA) Jonathan Tse conducted an unannounced annual visit at the facility. LPA met with Site Supervisor, Estrellita Guirre (D1). LPA explained the purpose of the visit. Present during the visit was D1, three staff, and 14 preschool age children. The facility is in compliance with staffing and ratio requirements on this day. The facility’s operating hours are from 7:30AM to 5:30PM. LPA inspected the facility for any health or safety hazards. LPA observed the facility to be in clean and orderly condition. There are fully charged 2A10BC fire extinguishers present in the facility. There is a carbon monoxide detector that was demonstrated to be operational. There is a fire alarm system present in the facility. Emergency exits are labeled and there are emergency exit routes posted. LPA observed waste containers to be fitted with tight-fitting lids. The children’s bathroom has four toilets and three hand washing sinks. Toilets were demonstrated to be operational. There is a staff restroom that is kept off-limits to children in care. Medication is stored in a central area and is out of reach of children in care. LPA observed medication to be labeled and stored with medical instructions. Off-limits areas are secured by childproof gates. LPA observed there to be age-appropriate toys and learning materials in the classroom. Furniture is age-appropriate and free of rough or sharp edges. There is a sand and a water play station present. Children are provided with cots and bedding to nap on. Bedding is stored and labeled separately. Bedding is provided by the facility and cleaned once a week. There are cubbies available for each child. The facility provides lunch and snacks for children in care. Lunch is cooked off-site and taken to the facility. Children are provided water from a non-contaminating source and are given cups to drink from. The facility tested its fixtures for lead on 10/29/2022 and did not have any exceedances of lead. Continued on Page Two

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Jonathan Tse	TELEPHONE: (650) 464-4927
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2024

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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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: CCFC-EDDY	FACILITY NUMBER: 380504742
	VISIT DATE: 04/05/2024

NARRATIVE

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LPA observed the outdoor play area to be free of debris and other loose articles. The outdoor play area is shared with other residents of the complex. During use of the outdoor play area, the facility secures off-limits areas with barricades or cones. Per D1, there are at least three staff supervising children. The facility provides age-appropriate toys and equipment during outdoor play. The outdoor play area has a play structure that is cushioned by resilient padding. There are no pools or other bodies of water in the facility. Per D1, there are no firearms or weapons stored in the facility.

LPA reviewed four staff files, six children’s files, and facility records. There is at least one staff member present with valid and current First Aid/CPR certification. LPA discussed Mandated Reporter Training requirements with D1. Immunizations are available for review. LPA observed all children’s files to be complete. LPA observed all required postings to be visible and accessible for review upon entry to the facility. The last emergency drill was conducted on 3/29/2024. Drills are properly logged and documented. Children are signed in and out upon entry to the facility via a paper sign-in sheet. LPA advised that lead testing results shall be posted and available for review.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

Facility representative was reminded that all adults 18 and over, 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.

Continued on Page Three

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Jonathan Tse	TELEPHONE: (650) 464-4927
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2024

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: CCFC-EDDY	FACILITY NUMBER: 380504742
	VISIT DATE: 04/05/2024

NARRATIVE

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Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).

LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. 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-carecenters/.

Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

There are no deficiencies issued during today’s visit on 4/5/2024. See LIC9102-TV for technical violation issued today regarding staff files. See LIC9102-TA for technical assistance given today regarding posting of lead testing results.
A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the facility representative, Estrellita Guirre.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Jonathan Tse	TELEPHONE: (650) 464-4927
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2024

LIC809 (FAS) - (06/04)

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