380505563-9-19-2019-05-CC-BVAN-BG6P3S-20190919105800

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 380505563
Report Date: 09/19/2019
Date Signed: 09/19/2019 10:58:10 AM

COMPREHENSIVE INSPECTION

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:	KAI MING HEAD START-DR. T. KONG LEE CENTER		FACILITY NUMBER:	380505563
ADMINISTRATOR:	LEI, IOK		FACILITY TYPE:	850
ADDRESS:	950 POWELL STREET		TELEPHONE:	(415) 982-4777
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94108
CAPACITY:	20	CENSUS: 11	DATE:	09/19/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:35 AM
MET WITH:	Lei, Iok		TIME COMPLETED:	11:00 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	On 9/19/19 at 8:35 A.M., Licensing Program Analyst (LPA) Van met with Assistant teacher, Lei KunFun, for an unannounced annual random inspection. The purpose of the inspection was explained, and was granted entry to the facility by assistant teacher. Director arrived moment later during the inspection of the facility. This is a Preschool program. Present today are 11 children with 3 teachers and a volunteer. Staff to children ratio are met. LPA observed that facility has an electronic sign in / out record with full legal signatures from parent or authorized representative. Days and hours of operations are from Monday - Friday 9:00 AM - 4:00 PM. LPA along with director inspected the center for health and safety hazards. The center is clean and orderly. Heating, lighting, and ventilation are adequate. LPA observed no pools, spas or other bodies of water on the premises. Per director, there are no firearms or weapons at the center. All cleaning supplies or other potentially harmful items are stored inaccessible to the children in care. This center provides Incidental Medical Service (IMS). Per director, this current school year, facility does not have any child on IMS plan. All furniture and equipment are in good repair and is free from loose sharp or pointed parts. The center provides snacks, breakfast, and lunch for children. Per director, food are prepared and delivered from chefables. LPA observed the food preparation area is clean, organize, and foods store appropriately. All solid waste storage containers have tight fitting lids. The facility has working carbon monoxide detector and smoke alarm installed. Drinking water is provided to the children by cups and pitchers. Cubbies are used to store children's belongings, and each cubby has child’s name labeled. The restroom is located in the classroom. LPA observed the children's restroom is clean, in good repair, and maintain adequate supplies. The water temperature is warm. There is a separate staff restroom. The isolation area for an ill child is located in the teacher's office. Continue on the next page...

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2019

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: KAI MING HEAD START-DR. T. KONG LEE CENTER	FACILITY NUMBER: 380505563
	VISIT DATE: 09/19/2019

NARRATIVE

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The facility has no outdoor space and was granted an outdoor waiver on Nov 2003. The facility uses several parks that are few blocks away from the facility, they are the Portsmouth Square Park at Kearny/Washington, Chinese Playground at Waverly/Sacramento and the Won Hei Park at Pacific/Powell for outdoor play space. LPA reminded director and staff to ensure that playground is cleared of any debris or harmful material before each use.

LPA reviewed personnel and children records. A sample of children's files were reviewed and found to have medical assessments, needs/services, and signed admission agreements. Staff files are organized, complete, and have documentation of education credits. Multiple staff members have record of valid CPR card in files and documentation of immunization for Measles, Pertussis and Influenza. There are menus posted at least one week in advance and are visible to the child's authorized representative. LPA also observed facility has posted the required forms (i.e. License, menus, waivers, Notification of Parent's Rights, Notification of Personal Rights, Car Seat Law, and Emergency Disaster Plan). Director stated Fire and Earthquake drills are done on a monthly basis, the last drill was logged 9/10/19.

LPAs reminded the director 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. LPA observed the facility has record of required immunization for all staff members.

LPA reviewed AB 1207 with the director. As of January 1, 2018, all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. LPA observed all staff members completed the online training, and certification are in file.

No deficiencies are cited today. The copy of this report is reviewed and provided to the director. Notice of site visit is posted and shall remain posted for next 30 days.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2019

LIC809 (FAS) - (06/04)

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