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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380505725
Report Date: 02/13/2020
Date Signed: 02/13/2020 03:38:35 PM

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:ST. NICHOLAS DAY CARE AND PRESCHOOL-INFANTFACILITY NUMBER:
380505725
ADMINISTRATOR:TUWAI, KATHYFACILITY TYPE:
830
ADDRESS:5200 DIAMOND HEIGHTS BLVD.TELEPHONE:
(415) 550-1536
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94131
CAPACITY:39CENSUS: 33DATE:
02/13/2020
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Director, Kathy Tuwai TIME COMPLETED:
03:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Luis J. Gomez met with director Kathy Tuwai. Purpose of the inspection was explained and is for a case management inspection. Present is the Director and 10 staff supervising 33 children. LPA Gomez inspected facility with director and inspected for health and safety hazards.

At 12:35am on February 13, 2020 LPA Gomez observed facility does not have all children present, properly signed-in with parent signatures. Director stated, the electronic sign-in system is currently in need of repair and cannot produce an active list of the children.

>Deficiencies were issued today under Title 22 Division 12 of the Ca. Code of Regulations.

> This report must be available in the facility for public review. Notice of site visit was observed being posted.
Director was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.cdss.ca.gov
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2020
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: ST. NICHOLAS DAY CARE AND PRESCHOOL-INFANT
FACILITY NUMBER: 380505725
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/13/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/21/2020
Section Cited

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101229.1 (a)(1) Sign In Sign Out. Licensee shall develop, maintain, and implement a written procedure to sign the children in/out of the child care center. (1)The person who signs the child in/out shall use his/her full legal signature and shall record the time of day.This requirement is not met as evidenced by.
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Based on observations and interviews conducted, LPA Gomez confired facility does not have all children present, properly signed-in with parent signatures. This poses a potential health and safety risk to children in care.
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Director will submit proof of correction LPA Gomez via email.

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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: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 02/13/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/13/2020
LIC809 (FAS) - (06/04)
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