380505320-9-14-2023-05-CC-BVAN-CVNQWB-20230914123138

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 380505320
Report Date: 09/14/2023
Date Signed: 09/14/2023 12:31:51 PM

Document Has Been Signed on 09/14/2023 12:31 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:	KROUZIAN-ZEKARIAN-VASBOURAGAN ARMENIAN PRESCHOOL		FACILITY NUMBER:	380505320
ADMINISTRATOR:	ANDONIAN, GRACE		FACILITY TYPE:	850
ADDRESS:	825 BROTHERHOOD WAY		TELEPHONE:	(415) 586-8686
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94132
CAPACITY:	42	CENSUS: 20	DATE:	09/14/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Grace Andonian		TIME COMPLETED:	01:00 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	During an unannounced annual inspection on September 14, 2023, Licensing Program Analyst (LPA) Van met with Director/Principal Grace Andonian to ensure compliance with regulations. The Director granted entry to the preschool program, and it was observed that there were five staff members present and 20 preschool children under their supervision. The facility complied with staff-children’s ratios, and all staff members had criminal record clearances on file. The facility operates Monday - Friday from 8:00 a.m. to 6:00 p.m. The Director and LPA conducted a thorough inspection of the physical plant to identify potential health and safety hazards. The facility has manual sign-in/out records. LPA reminded the Director to check and ensure all parents' signatures matched and accounted for the number of children present. The facility is in excellent condition and maintains proper temperature and ventilation levels. Age-appropriate toys and educational materials are available in each classroom, and the furniture is sturdy and well-maintained. Moreover, the facility is equipped with multiple combination carbon monoxide and smoke detectors, fully charged fire extinguishers, and functioning telephones. LPA noticed that each child has cubbies, and emergency supplies are securely stored. First aid supplies are fully stocked and readily accessible to children. All hazardous materials, including cleaning solutions and poisons, are stored out of reach of children. Likewise, sleeping cots are appropriately stored, and medications are securely kept in locked cabinets. The toilets and handwashing sinks are in good working condition and regularly sanitized. Lastly, LPA confirmed that no bodies of water are on the premises. Continued on page 2...

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023

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 09/14/2023 12:31 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: KROUZIAN-ZEKARIAN-VASBOURAGAN ARMENIAN PRESCHOOL	FACILITY NUMBER: 380505320
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/14/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

101700.3(b)(1)

101700.3 California Lead Action Level at Child Care Centers (b)(1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on results received from the certified water samplers, the facility exceeded 5.5 ppb of lead in their water source. This poses a potential health, safety, or personal rights risk to persons in care.
	POC Due Date: 10/16/2023
	Plan of Correction
1 2 3 4	The facility took immediate and proper actions to remediate the fixtures. The facility has posted signs and plans to replace the affected fixtures and will be flushing the water fixtures until they are retested with a certified water sampler by 10/16/2023. The director will provide the new test results to LPA no later than 10/16/2022.

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: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023

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: KROUZIAN-ZEKARIAN-VASBOURAGAN ARMENIAN PRESCHOOL	FACILITY NUMBER: 380505320
	VISIT DATE: 09/14/2023

NARRATIVE

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The facility presently has an outdoor waiver granted by the Department allowing no more than 19 children to be in the playground at one time. The outdoor play area is maintained clean and clutter-free. It is also securely fenced and well-maintained to ensure the safety of all children. Play structures are checked regularly for damage and loose parts, with soft cushioning placed beneath them to prevent injuries from accidental falls. LPA reminded the Director to check and clear any debris or harmful material from the playground before use in accordance with regulations.

During the inspection, LPA reviewed records pertaining to children and personnel. Children’s records revealed that the facility has complete records of each child, including their names, addresses, and authorized representative telephone numbers. Additionally, each child's file contains information about their immunization record, medical assessment, and admission agreement. Staff members' records showed that all individuals requiring caregiver background checks had undergone criminal records and child abuse index clearances or exemptions. Furthermore, several staff members possess valid CPR certificates, and all staff maintain up-to-date immunization records. LPA examined the educational qualifications of the staff and confirmed that everyone had completed the required ECE units. The Center's Director informed us that they conduct fire and earthquake drills monthly, with the most recent drill occurring on August 30, 2023.

The facility had posted the required forms. (i.e., License, waivers, Notification of Parent's Rights, Notification of Personal Rights, Car Seat Law, Emergency Disaster Plan, and Daily activities). Per the Director, the Center provides lunch and two snacks to children. Waters are readily available for children indoors and outdoors. All storage containers for solid waste within the Center have a proper tight-fitting cover.
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SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023

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: KROUZIAN-ZEKARIAN-VASBOURAGAN ARMENIAN PRESCHOOL	FACILITY NUMBER: 380505320
	VISIT DATE: 09/14/2023

NARRATIVE

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The 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 a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Incidental Medical Services (IMS) policy was discussed. 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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

The Director was informed about Mandated Reporter training. In addition to AB1207 training required to be completed every two years by the Licensee and all staff hired, a one-time General Training is also required. Training can be taken online at www.mandaterreporterca.com. Also, the Director was reminded of Pesticide training. Information on the DPR website at: www.cdpr.ca.gov/shoolipm/childcare

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

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.
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SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023

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: KROUZIAN-ZEKARIAN-VASBOURAGAN ARMENIAN PRESCHOOL	FACILITY NUMBER: 380505320
	VISIT DATE: 09/14/2023

NARRATIVE

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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).

The Center completed testing and is in the process of remediating LEAD exceedances,

During the inspection, LPA requested the following document be sent to the Licensing office by September 29, 2023, to complete the annual inspection.
1. An up-to-date Emergency Disaster Plan (LIC 610)
2. Personnel Report (LIC 500)
3. Designation of Administrative Responsibility (LIC 308)
4. Administrative Organization (LIC 309)
5. Incidental Medical Services Plan
6. Basic Pest Management Training completion for all staff
7. Updated immunization record for the Director

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

See LIC809D for deficiency cited. An exit interview was conducted, and the report was reviewed with the Director, Grace Andonian Today's report and site visit notice were provided to the Director. LPA informed the director that the site visit notice must be posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023

LIC809 (FAS) - (06/04)

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