380505039-8-23-2019-05-CC-WLYY-BFBP7R-20190823110422

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 380505039
Report Date: 08/23/2019
Date Signed: 08/23/2019 11:04:30 AM

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:	CCFC-30TH AVENUE		FACILITY NUMBER:	380505039
ADMINISTRATOR:	SEAN OWENS		FACILITY TYPE:	850
ADDRESS:	741 30TH AVENUE		TELEPHONE:	(415) 668-6539
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94121
CAPACITY:	29	CENSUS: 19	DATE:	08/23/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Zilu Zhu		TIME COMPLETED:	11:30 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	Licensing Program Analyst (LPA) Winnie Ly conducted an unannounced annual visit and met with Site Supervisor, Zilu Zhu during the visit. Purpose of the inspection was explained. There are 19 children 4 staff members. Teacher to child ratios were met on this day. The facility has fully charged fire extinguishers that meet the minimum requirements. Smoke detectors, and carbon monoxide detector were observed. The facility operates Monday - Friday from 7:30 AM to 5:30 PM. The center has binders by the front entrance for parents to sign in and out. All children were signed in during the inspection. Thirty minutes into the inspection Director Sean Owens arrived. Director contacted administrator Frank Toy to deliver staff files over so LPA can review. LPA and Site Supervisor inspected the center for Health and Safety Hazards. There are no pools, spas or other bodies of water on the premises. Per the Site Supervisor, there are no firearms or weapons in the center. Adequate first aid supplies are available. All cleaning supplies and other potentially harmful items are stored inaccessible to the children. Medications are stored in the office on the shelf inaccessible to children. LPA reviewed medication procedures with staff. If there was an ill child, staff would separate the child while waiting for a parent to pick them up. Furniture and equipment are in good condition, free from loose, sharp or pointed parts. Children's bathrooms are in working order with adequate supplies. There is separate restroom on site for adults. The food prep area is clean and orderly. The center provides breakfast, lunch and snack. Menus are posted in the center. All solid waste storage containers have tight fitting lids. Drinking water is available to children by water pitcher and disposable cups. Cont...Page 2

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Winnie Ly	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2019

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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: CCFC-30TH AVENUE	FACILITY NUMBER: 380505039
	VISIT DATE: 08/23/2019

NARRATIVE

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LPA and Site Supervisor also toured the outdoor play area for Health and Safety Hazards. LPA observed outdoor equipment is in good condition, free from loose, sharp or pointed parts. The play structure appears to be age appropriate for children in care. Areas under slides and other climbing equipment is adequately cushioned. Last Emergency Drill was conducted on August 20, 2019 and properly logged. A random sample of children's and staff’s files were reviewed and found to be complete. At least one staff have current Pediatric First Aid and CPR. Facility has posted all the required licensing forms in a prominent visible location.

CCC providing IMS: Facility has children that need IMS at this time and has a plan on file. Incidental Medical Services (IMS) policy was discussed and reviewed . For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Facility was also informed that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662. All staff have proof of Immunization.

LPA discussed Child Abuse Mandated Training AB1207 with the Director. As of January 1, 2018 all staff will be required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

Director was also advised to reach out to San Bruno Regional Office for concern or questions. Desk Duty is available M-F, 8a.m.-5p.m. (650) 266-8800. Website for forms and regulations updates: www.cdss.cs.gov/inforesources/Community-Care-Licensing

No deficiencies were observed today. A copy of this report was reviewed and provided to the licensee. Notice of Site Visit was observed to be posted and shall remain posted for 30 days.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Winnie Ly	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2019

LIC809 (FAS) - (06/04)

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