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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380504984
Report Date: 03/20/2023
Date Signed: 03/20/2023 04:50:06 PM


Document Has Been Signed on 03/20/2023 04:50 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:KATHERINE MICHIELS SCHOOLFACILITY NUMBER:
380504984
ADMINISTRATOR:ANCHETA, YOLANDAFACILITY TYPE:
830
ADDRESS:1335 GUERRERO STREETTELEPHONE:
(415) 821-0130
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY:15CENSUS: 14DATE:
03/20/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Yolanda AnchetaTIME COMPLETED:
04:55 PM
NARRATIVE
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On 3/20/2023 at 1:10PM., Licensing Program Analyst, Luis J. Gomez met with Director, Yolanda Ancheta. Purpose of the inspection was explained and is for an Unannounced Annual/ Random inspection. This is a combination center, with a preschool program on-site. Present was director and four staff supervising 14 children. Staff present had criminal record clearances of file. Infant program utilizes one classroom (playroom), napping room and one, shared, outdoor play space. Hours of operation are Monday- Friday 8:00am- 6:00pm. Program operates year-round. LPA inspected facility, indoors and outdoors, for health and safety hazards.

At 1:20PM., LPA observed the following. Infant classroom was clean, orderly, with plenty of age-appropriate toy and playthings available. Floors and surfaces were free of obstructions. Classroom are equipped with hangers for storage of children’s belongings. LPA observed diaper changing tables locating was within arm’s reach of a sink. Food preparation area is located separate, with refrigeration and shelves for added storage. LPA observed infant bottles of milk, and supplies and all correctly stored and labeled with children's names.

At 1:20PM., Based on observation, LPA confirmed exposed piping located in infant playroom area.


At 1:25PM., Based on observations, LPA confirmed infant bouncer chair located in the infant playroom area.

For napping services, LPA observed infant cribs or cots located in napping room. Cribs available are with tight-fitting sheet and properly sized mattresses. Infant cribs have visibility on all sides for constant supervision. Per director, children’s napping linins and sheets are washed weekly by families. Classrooms has acceptable ventilation and lighting. Trash bins and outlets have been properly covered. (REFER TO 809C FOR CONT.)
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 03/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/20/2023
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 5


Document Has Been Signed on 03/20/2023 04:50 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: KATHERINE MICHIELS SCHOOL
FACILITY NUMBER: 380504984

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/20/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101239(n)
Fixtures, Furniture, Equipment and Supplies
(n) Furniture and equipment shall be maintained in good condition, free of sharp, loose or pointed parts.

This requirement is not met as evidenced by:
Deficient Practice Statement
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At 1:20PM., Based on observation, LPA confirmed exposed piping located in infant playroom area. This poses a potential health and safety risk to children in care.
POC Due Date: 04/03/2023
Plan of Correction
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Director will ensure pipe is made inaccessible to children by the due date: 4/3/2023. Proof of correction will be submitted to the Department via email.
Type B
Section Cited
CCR
101439(d)(2)
Infant Care Center Fixtures, Furniture, Equipment and Supplies
(d) Swings, playpens and all such equipment and furniture shall be assembled or installed according to the manufacturer's instructions, and shall be maintained in good repair and safe condition. (2) A baby walker shall not be allowed on the premises of a child care center in accordance with Health and Safety Code Section 1596.846.

This requirement is not met as evidenced by:
Deficient Practice Statement
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At 1:25PM., Based on observations, LPA confirmed infant bouncer chair located in the infant playroom area. This poses a potential health and safety risk to children in care.
POC Due Date: 03/22/2023
Plan of Correction
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Director will remove all bouncers from facility by the due date: 3/22/2023. Proof of correction will be submitted to the department via email.
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 ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 03/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/20/2023
LIC809 (FAS) - (06/04)
Page: 2 of 5


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: KATHERINE MICHIELS SCHOOL
FACILITY NUMBER: 380504984
VISIT DATE: 03/20/2023
NARRATIVE
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(Page 2)
Staff restrooms are in the facility hallway. Detergents, cleaning supplies and sharp/ hazardous objects were made inaccessible. Classroom had a smoke/ carbon monoxide combination detector and a fully charged fire extinguisher (2A:60BC) located in the hallway.

At 1:45PM., LPA inspected the outdoor play area. Area is completely enclosed, with sand for added safety. Outdoor play area was kept clean, free of debris or hazardous plants. Outdoor equipment was in good repair and properly anchored. Director sandbox is inspected daily by facility staff. For water services, staff provided children fresh water with refillable water bottles.

At 2:05PM., LPA reviewed 5 children’s files and 4 personnel files. Children files were reviewed and included the: Infant Needs and Services Plan, Consent for Medical Treatment (LIC627), Identification of Emergency Information (LIC700), Individual Sleeping Plan (LIC9227), Updated Immunization Records; and Admissions Agreement.

LPA reminded facility to perform infant napping checks, for all children every 15 minutes.

Staff files contained the: Notice of Employee Rights (LIC9052); Education Verification; Personnel Record; and updated ‘Mandated Reporter Training’ certifications (AB1207).

Staff’s CPR/ 1st Aide Certification was Current, expiring: 11/14/2024.

At 2:35PM., Based on record review, LPA confirmed staff member, S1, proof of immunization missing from facility files.

Emergency disaster drills are being conducted at the facility, with last drill completed on, 9/25/2022 and properly logged. Director stated families provide all daily snack and meals for day-care children. All required posting were observed in the facility including the: Facility License; Emergency Disaster Plan (LIC612); Seat Beat Safety Laws; Notification of Parent’s Rights (LIC995A). (REFER TO 809C, FOR CONT.)
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2023
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: KATHERINE MICHIELS SCHOOL
FACILITY NUMBER: 380504984
VISIT DATE: 03/20/2023
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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

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.

LPA discussed safe sleep regulations with the director and discussed Child Care Licensing Safe Sleep webpage at http://www.cdss.ca.gov/inforesource/child-care-licensing/public-information-and-resouce/safe-sleep as an additional resource. LPA also informed director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at: http://www.cpsc.gov/ and recommend they register all infant devices with the CPSC to be notified of any recalls on their purchased requirement.

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 report was reviewed with Director, Yolanda Ancheta, and her 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 ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2023
LIC809 (FAS) - (06/04)
Page: 5 of 5