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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380505534
Report Date: 01/12/2023
Date Signed: 01/12/2023 04:46:44 PM


Document Has Been Signed on 01/12/2023 04:46 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:FAMILY DEVELOPMENTAL CENTER (INFANT)FACILITY NUMBER:
380505534
ADMINISTRATOR:BELL, EBONYFACILITY TYPE:
830
ADDRESS:2730 BRYANT STREETTELEPHONE:
(415) 282-1090
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY:95CENSUS: 52DATE:
01/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:05 PM
MET WITH:Dee LeeTIME COMPLETED:
04:50 PM
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On 1/12/2023 at 12:05PM., Licensing Program Analyst, Luis J. Gomez met with Early Learning and Family Support Senior Director, Rorsaura Diaz and Administrative Director, Dee Lee. 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 Admin. and 18 staff supervising 52 children. Facility was operating within capacity limits of the license. All staff had their criminal record clearance of file. Infant/ toddler program utilizes six classrooms: 107- Little Bears (18-36 Months of Age), 105- Rainbow (0- 24 Months of Age), 119- Stars (18-36 Months of Age), 122- Lady Bugs (0-24 Months of Age), 124- Caterpillar (0-24 Months of Age), 132- Butterfly (18- 36 Months of Age) and one, shared, Outdoor Play Yard. LPA observed outdoor waiver posted in lobby. Hours of operation are Monday- Friday 7:30am- 4:30pm. Program operates year-round. LPA inspected facility, indoors and outdoors, with Admin. for health and safety hazards.

At 12:30AM., LPA observed the following. Infant/ Toddler classrooms were clean, orderly, with plenty of age-appropriate toy and playthings available. Floors and surfaces were free of obstructions. Classrooms had been separated into several sections using room dividers. Classroom are equipped with cubbies for storage of children’s belongings. LPA observed diaper changing tables locating was within arm’s reach of a sink. Food preparation areas were made inaccessible with proper refrigeration and lockable cabinets for added storage. LPA observed infant milk, bottles and all food items correctly stored and labeled. For napping services, each infant was provided their own labeled crib or cot. Cribs available are with tight fitting sheet and properly sized mattress. Infant cribs have visibility on all sides for constant staff supervision. Per Admin., children’s napping linins and sheets are washed weekly, and daily if needed. Classroom had acceptable ventilation and natural lighting. Trash bins and outlets have been properly covered. Toddler classrooms are equipped with children’s bathrooms with adequate supplies. Fixtures were in operating condition. (REFER TO 809C FOR CONT.)

SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 01/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/12/2023
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 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: FAMILY DEVELOPMENTAL CENTER (INFANT)
FACILITY NUMBER: 380505534
VISIT DATE: 01/12/2023
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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 detector, carbon monoxide detector and a fully charged fire extinguisher (2A:60BC) located in the hallway.
At 1:30PM., LPA inspected infant outdoor play area. LPA observed area had been completely enclosed with tall fencing. Area is equipped with soft padding for added safety. Outdoor play area is kept clean, free of debris or hazardous plants. All outdoor equipment was in good repair and properly anchored. Per Admin. sandbox is covered daily by facility staff. For water services, staff provided fresh water with disposable cups.

At 2:00PM., During inspection, LPA review 8 children’s files and 18 personnel files. Required Immunization, Proof of Education, Notice of Employee Rights (LIC9052) and Criminal Record Statement (LIC508). Present staff members, S1, had their current CPR/ 1st aid certification on file which expires: 04/23/2023.

At 2:50PM., Based on record review and interviews, LPA confirmed staff is not documenting infant napping conditions for each 15 minutes review. Advisory Note: Technical Violation (LIC9102TV) was issued.

Children files were reviewed and included following: 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.

Emergency drills (fire and earthquake) are being conducted at the facility, with last drill completed on, 12/15/2022 and 10/15/2022, and was properly logged. Per Admin. program provide all daily snack and meals for day-care children. All required posting were observed in the facility lobby. (REFER TO 809C, FOR CONT.)
SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023
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: FAMILY DEVELOPMENTAL CENTER (INFANT)
FACILITY NUMBER: 380505534
VISIT DATE: 01/12/2023
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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

Admin. 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, no deficiencies were observed in the areas evaluated according to the Title 22 Division 12 Ca. Code of Regulations. Exit interview conducted and report reviewed with Dee Lee, 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: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023
LIC809 (FAS) - (06/04)
Page: 4 of 4