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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380504984
Report Date: 01/29/2020
Date Signed: 01/29/2020 04:28:38 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 SCHOOLFACILITY NUMBER:
380504984
ADMINISTRATOR:ZELLERBACH, LAURA ROSEFACILITY TYPE:
830
ADDRESS:1335 GUERRERO STREETTELEPHONE:
(415) 821-1434
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY:15CENSUS: 13DATE:
01/29/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Director, Yolanda AnchetaTIME COMPLETED:
04:35 PM
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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. This is a combination center, with a preschool program on site. Infant program utilizes the playroom (primary playroom, infant area, snack area), Napping room and outdoor play area #1. Hours of operation are Monday- Friday 7:00am- 6:00pm. Infant program operates year around. Present is the Director and three staff supervising 13 children. Facility is operating within capacity limits of the license on this day. LPA Gomez inspected facility with director for health and safety hazards.

At 1:55pm on January 29, 2020 LPA inspected the infant playroom. Playroom is clean, organized and has plenty of age appropriate blocks, toys and materials for the children. Playroom has cubbies, several child size tables and chairs for snack and activities. Diaper changing tables, located in the playroom, is within arm’s reach of a sink. Playroom is equipped with a refrigerator and cabinets for storage. The staff restrooms are located upstairs. All bottle and milk were inspected and are properly stored and labeled. Each child has their own assigned crib available in the napping room. Trash cans are properly covered. At 2:00pm on January 29, 2020 LPA observed an infant child, in a baby bouncer, in the snack area. Director removed bouncers during today's inspection. All detergents, cleaning supplies and toxins are made inaccessible, stored in an off-limits area. There is acceptable ventilation. Playroom has a smoke detector and a fully charged fire extinguishers (2A:40BC) located in the facility hallway. First aid kits is available.

(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 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
FACILITY NUMBER: 380504984
VISIT DATE: 01/29/2020
NARRATIVE
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(Page 2)
At 2:30pm on January 29, 2020 LPA inspected the facility outdoor play area. LPA observed outdoor play area is completely enclosed. Outdoor play area is kept clean, free of debris and hazardous items. All outdoor equipment is in good repair. Per director, staff provides supervision while children are free to explore.

Three children and two personnel records were reviewed. All children files reviewed are complete. 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. At 3:00pm on January 29, 2020 LPA Gomez observed facility employee is present with the children, without the proper facility association. Per director, parent’s provide all daily snack and meals for children in care. Facility refrigerator is maintained clean, with all children’s milk stored and properly labeled.

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
· 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

(Continuation 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 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
FACILITY NUMBER: 380504984
VISIT DATE: 01/29/2020
NARRATIVE
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Based on today's inspection, deficiencies were observed in the areas evaluated according to the Title 22 Division 12 Ca. Code of Regulations and documented on the 809-D. Exit interview and plan of correction was developed 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 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
FACILITY NUMBER: 380504984
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/29/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/31/2020
Section Cited

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101170(e)(2) Criminal Record Clearance. Prior to working or volunteering in a licensed child care facility, all individuals subject to criminal record review shall request a transfer of criminal record clearance to another facility. The requirement is not met as evidenced by.
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Based on a file review, interviews conducted with director and observations, LPA confirmed facility employee is present with the children, without the proper facility association. This is a potential health and safety risk to children in care.
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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: 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 appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/29/2020
LIC809 (FAS) - (06/04)
Page: 4 of 4