380505725-11-3-2021-05-CC-CQUO-C8EV3P-20211103160502

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 380505725
Report Date: 11/03/2021
Date Signed: 11/03/2021 04:06:36 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-INFANT		FACILITY NUMBER:	380505725
ADMINISTRATOR:	TUWAI, KATHY		FACILITY TYPE:	830
ADDRESS:	5200 DIAMOND HEIGHTS BLVD.		TELEPHONE:	(415) 550-1536
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94131
CAPACITY:	39	CENSUS:	DATE:	11/03/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Director, Kathy Tuwai		TIME COMPLETED:	04:30 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 3, 2021 at 8:40am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced annual, required inspection. LPA met with director, Kathy Tuwai and explained the purpose of the inspection. Facility is a combination center of a preschool and infant program. Facility is located in the lower level of St. Nicholas Orthodox Church. Hours of operation are Monday to Friday 7:45am to 5:30pm. Under infant license, there were 7 staff members (including director) with 21 infants at time of inspection. Facility is currently operating within teacher to child ratio. LPA inspected entire facility for health and safety hazards. Infant classroom is separated into 5 different sections for 3 separate age groups. Sections include eating area, napping area, and play areas. Storage for infants' belongs are located inside the classroom, labeled with each child's individual names. LPA observed facility has multiple carbon monoxide detectors, multiple charged fire extinguishers, and fire alarm system installed. Facility has a working telephone on site. All poisons, cleaning solutions and hazardous materials are stored inaccessible to children. Facility has age appropriate furniture and materials for crawling, balancing and walking infants. There were a variety of age appropriate toys for children in care. Cribs and cots are provided to napping infants. Changing tables are located in infant classroom, within arm's reach of a sink. Facility provides food service to older infants and toddlers. Formulas and diapers are provided by parents for younger infants. LPA inspected kitchen and food prep areas, which were observed to be clean, neat and orderly. All food is stored and prepared properly to avoid contamination. (Continue Report on Page 2...)

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8864
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021

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: 11/03/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101220.1(g)

Immunizations

(g) The licensee shall document each child's immunizations and shall maintain such documentation in the center for as long as the child is enrolled. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview and record review, the facility did not comply with the section cited above. 3 out of 10 children's (whom have attended program for at least 7 months) files did not have immunization records, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/30/2021
	Plan of Correction
1 2 3 4	Director to provide LPA proof of missing children's immunization records via email no later than 11/30/2021 by 5:00pm.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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	TELEPHONE: (650) 266-8864
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021

LIC809 (FAS) - (06/04)

Page: 2 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: ST. NICHOLAS DAY CARE AND PRESCHOOL-INFANT	FACILITY NUMBER: 380505725
	VISIT DATE: 11/03/2021

NARRATIVE

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Infant program shares "outdoor area" / atrium with preschool program on a rotation schedule. Director is aware infant and preschool children are not to use atrium at same time. LPA observed atrium to have sufficient toys and materials that were in good working condition. Poles located in atrium are adequately padded.

Children are signed in and out of facility by parents' written signatures. Facility has license documentation and information properly posted and available for review.

LPA reviewed facility records that included 10 children's records and 7 staff binders (whom were present during inspection). LPA reviewed 3 out of 10 children's records were not maintained with immunization records.

Director's CPR and First Aid are current and will expire January 2022. Last emergency drill conducted June 6, 2021. Emergency drills are conducted once every 6 months and are properly logged and documented.

Facility was 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.

Director is aware that all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. LPA observed the completion certificate on file. LPA encourages the director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

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SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8864
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021

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: ST. NICHOLAS DAY CARE AND PRESCHOOL-INFANT	FACILITY NUMBER: 380505725
	VISIT DATE: 11/03/2021

NARRATIVE

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Director 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 a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with director and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/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 https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. Program is providing IMS at this time. 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 cited for a Type B citation for incomplete children's records. Please refer to 809D for more information.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with director, Kathy Tuwai.

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8864
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021

LIC809 (FAS) - (06/04)

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