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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380505568
Report Date: 01/20/2022
Date Signed: 01/20/2022 04:17:39 PM

Document Has Been Signed on 01/20/2022 04:17 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 (PRESCHOOL)FACILITY NUMBER:
380505568
ADMINISTRATOR:QUIROZ, YOHANAFACILITY TYPE:
850
ADDRESS:2730 BRYANT STREETTELEPHONE:
(415) 282-1090
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY: 83TOTAL ENROLLED CHILDREN: 83CENSUS: 45DATE:
01/20/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Melissa SeranoTIME COMPLETED:
04:30 PM
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On 1/20/2022 at 8:45A.M., Licensing Program Analyst (LPA), Luis J. Gomez met with Administrator, Melissa Serano. Purpose of the inspection was explained and was for an unannounced Annual/ Random inspection. This is a combination center, with an infant toddler program on-site. Facility operates under title five regulations. Present was the Administrator and 11 staff supervising 45 children. Children present are preschool age. Preschool program operates out of four classrooms: Sunshine (2-3 years old), Starfish (2-3 years old), Bumble Bees (3-5 years old), Blue Birds (3 – 5 years old) and one shared outdoor play yard. Outdoor space waiver was observed during inspection. Hours of operation are Monday- Friday 7:30am- 4:30pm. Program operates year around. LPA inspected facility, indoors and outdoors, for health and safety hazards.

At 9:45A.M., LPA observed the following: Classrooms were clean and orderly with a variety of age-appropriate books, blocks and supplies for the children. All floors and surfaces were free of obstructions. Classrooms had labelled cubbies for storage of children's belongings. Classroom manipulative were free of sharp edges or splinters. Classrooms had child sized tables and chairs for snack and activities.

At 10:38A.M., Based on observations, LPA confirmed broken cabinet, accessible to day-care children, located in classroom #4, (Blue Birds). During inspection, Advisory Note: Technical Violation was issued. Children's bathroom and all fixtures including toilet and sinks were in operating condition. Bathrooms had adequate supplies for the children. Staff restroom are located separately. For napping services, program provides cleanable napping cots, which are assigned to each child. Per Administrator, children's napping supplies are taken home weekly to be cleaned. Classrooms had acceptable ventilation and lighting. Detergents, cleaning supplies, sharp objects and toxins are made inaccessible, stored inaccessible to children. All classrooms have a smoke detector, carbon monoxide detector and fully charged fire extinguishers (2A:60BC) located in the hallway. (REFER TO 809-C FOR CONT.)

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 01/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/20/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: FAMILY DEVELOPMENTAL CENTER (PRESCHOOL)
FACILITY NUMBER: 380505568
VISIT DATE: 01/20/2022
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At 10:45A.M., LPA inspected the outdoor play area. Outdoor play area was completely enclosed with tall fencing and equipped with proper shading. Area was free of debris or hazardous items. Playthings inspected were in good repair. Play structure was properly anchored. Per Administrator, water service are provided using disposable cups. LPA reviewed facility shed during inspection.

At 11: 00A.M LPA review facility records including 10 children’s files and 11 personnel files. Staff files reviewed and included: Health Screening (LIC503), Required Transcripts, Declaration to Report Suspected Child Abuse (LIC9108). All staff had their required mandated reporter certification training on file. 11:45A.M., Based record review, LPA confirmed staff, S10, missing proof of required immunization from staff files. During inspection, Advisory Note: Technical Violation was issued.

At 1:00P.M., Based on observations, interviews and record review, LPA confirmed staff member, S9, present without proper criminal record clearance or association on file. Per Administrator, staff member has been fingerprinted for her California Teaching Credential.

Children’s files reviewed included: Consent for Medical Treatment (LIC627), Identification of Emergency Information (LIC700) and Parent’s Rights. LPA reminded Administrator to ensure all children’s proof of Immunization and stored in the facility file and updated regularly.

Present staff members had their current CPR/ 1st aid certification, which expires: 4/2023. Emergency drills are conducted at the facility, with the last drill done on 12/16/2021, properly logged. Per Administrator, facility provides meals for day-care children. LPA observed updated snack/ lunch schedule posted during inspection. Refrigerator were observed to be clean and in proper use. All required posting were observed in the facility included the License, Parents Rights (PUB393), Emergency Disaster Plan (LIC610). During inspection, LPA reviewed children’s medication stored in classrooms.

(REFER TO 809-C FOR CONT.)

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2022
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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: FAMILY DEVELOPMENTAL CENTER (PRESCHOOL)
FACILITY NUMBER: 380505568
VISIT DATE: 01/20/2022
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Administrator 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.

Based on today's inspection, deficiencies were observed in the areas evaluated according the Title 22 Division 12 Ca. Code of Regulations. Exit interview was discussed with Administrator, Melissa Serano and her signature of this form acknowledges receipt of these documents.



Type “A” violation was issued today. Licensee was advised to provide a copy of the Evaluation Report and all Type “A” Deficiencies cited, to parents and guardians of children currently enrolled in care and to parents of newly enrolled children during the next 12 months. A signed and dated LIC 9224 (Deficiency and Acknowledgment of Receipt of Licensing Reports) shall be maintained in all children's files.

A civil penalty of $100 was assessed.

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

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2022
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Document Has Been Signed on 01/20/2022 04:17 PM - It Cannot Be Edited


Created By: Luis Gomez On 01/20/2022 at 03:08 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: FAMILY DEVELOPMENTAL CENTER (PRESCHOOL)

FACILITY NUMBER: 380505568

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 01/20/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101170(e)
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:

This requirment was not met as evidenced by:
Deficient Practice Statement
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At 1:00P.M., Based on observations, interview and record review, LPA confirmed staff member, S9, present without proper criminal record clearance or association on file.
POC Due Date: 01/21/2022
Plan of Correction
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Facility will ensure staff member receives proper criminal record clearance and association by the due date: 1/21/2022. Facility will submit proof of correction to Department via email.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Cindy Interiano
LICENSING EVALUATOR NAME:Luis Gomez
LICENSING EVALUATOR SIGNATURE:
DATE: 01/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/20/2022


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