380505334-11-1-2022-05-CC-WLYY-CKRVL9-20221101163130

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 380505334
Report Date: 11/01/2022
Date Signed: 11/01/2022 04:31:45 PM

Document Has Been Signed on 11/01/2022 04:31 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	SFUSD-NORIEGA (EES) SCHOOL AGE		FACILITY NUMBER:	380505334
ADMINISTRATOR:	NG, IVY		FACILITY TYPE:	840
ADDRESS:	1775 44TH-AVENUE		TELEPHONE:	(415) 759-2853
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94122
CAPACITY:	112	CENSUS: 50	DATE:	11/01/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Ivy Ng		TIME COMPLETED:	03:15 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 November 01, 2022, at approximately 1:30pm, Licensing Program Analyst (LPA) Winnie Ly conducted an Unannounced Required - 1 Year Inspection this day and met with Principal, Ivy Ng. Purpose of the visit was explained. Present during the visit were the 6 staff caring for 50 children. Program operates M-F after school 2:00pm-6:00pm during the School year. Summer M-F 8:00am-6:00pm. Facility operates during Spring Break. Facility closed for Winter Break. Facility has posted all the required licensing forms in a prominent visible location. LPA and Principal toured the school age classrooms, Room 7, Room 9 and Room 11 for Health and Safety Hazards. The classrooms were clean and orderly. There are no bodies of water present at the center. Disinfectants, cleaning solutions and other potentially harmful items were inaccessible to the children. Medications are stored out of reach of the children. The furniture and equipment are in good condition, free of sharp, loose or pointed parts. All solid waste storage containers have secure, tight fitting lids. Snack is provided by the center in the afternoon. Snack menus are posted in each classroom. Drinking water is available by water bottles both indoor and outdoor. Each classroom is equipped with a fully charge fire extinguisher, smoke detectors and carbon monoxide detectors. Females restrooms and males’ restroom are separated from each other. All restrooms were in safe and sanitary operating condition. LPA observed outdoor equipment is in good condition. The play structure appears to be age appropriate for children in care. Areas under slides and other climbing equipment is adequately cushioned. Facility uses clipboard to sign children in and out of the program. Last Emergency Drill was conducted on 10/20/2020 and is properly logged. First Aid Kit and Emergency supplies are properly maintained and kept inaccessible to children. Cleaning products and Toxins are maintained inaccessible to children. A random sample of children's files were reviewed and found to be complete. LPA also reviewed staff files and found to be complete. At least one staff have current Pediatric First Aid and CPR. CONTINUED>>>

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Winnie Ly	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2022

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: SFUSD-NORIEGA (EES) SCHOOL AGE	FACILITY NUMBER: 380505334
	VISIT DATE: 11/01/2022

NARRATIVE

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This facility does not have children that need IMS at this time. 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 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.

Pesticide regulations were discussed with the Director. In accordance with the Healthy Schools Act, California law requires that anyone using any pesticide must be trained every year in integrated pest management and the safe use of pesticides around children. The director was advised that a free one hour online course is available on the Department of Pesticide Regulation's Web site: www.cdpr.ca.gov/schoolipm/training. For questions, email ccipmlist@cdpr.ca.gov.

Principal 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

An Exit Interview was conducted with the Principal. No deficiencies were issued today under Title 22 Division 12 of the California Code of Regulations. A copy of this report and appeal rights were discussed and left with Principal whose signature on this form confirm receipt of these reports. Notice of Site Visit was posted. Notice to remain posted for 30 days. For updates on Licensing information, go to CCL website: www.ccld.ca.gov. For Provider Information Notice: ccld.ca.gov/PG5098.htm

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Winnie Ly	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2022

LIC809 (FAS) - (06/04)

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