380505725-10-20-2023-05-CC-CQUO-CWSUNN-20231020154414

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 380505725
Report Date: 10/20/2023
Date Signed: 10/20/2023 03:44:23 PM

Document Has Been Signed on 10/20/2023 03:44 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
SAN BRUNO CC RO, 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: 17	DATE:	10/20/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Kathy Tuwai		TIME COMPLETED:	04:15 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 October 20, 2023 at approximately 9:00am, Licensing Program Analysts (LPAs) Catrina Quimbo and Man Tso, conducted an unannounced annual inspection. Upon arrival, LPAs met with teaching staff, TA2, and explained the purpose of the visit. Per teaching staff, director had a pre-scheduled appointment. LPAs continued annual inspection. Program is a combination center of a preschool and infant program. Hours of operation are Monday to Friday 7:45am to to 5:30pm. For the infant license, there is one classroom: Caterpillars. Present during LPAs' visit included 17 infants with 8 teaching staff. LPAs inspected the facility and all classrooms for health and safety hazards. Program separates young infants to the back portion of the classroom (newborn to walking age) and the older infants to the front portion of the classroom (walking age to 2 years old). Barrier in the classroom includes a fence with a transparent wall. Storage for children's belongings is located inside the classroom, labeled with children's individual names. LPA observed infant classroom to be clean, with proper temperature and ventilation. Both the front portion and the back portion of the classroom includes separate areas for infants' activities, sleeping and eating. LPAs observed infant classroom to be clean, with proper temperature and ventilation. Flooring for infants includes carpet, rugs and floor pads for walking and crawling infants. Toys and materials were observed to be clean and in good condition. Diaper changing tables are within arm's reach to an adult sink. Garbage bins to dispose of soiled diapers were observed to have tight fitting lids. At approximately 9:40am, director, Kathy Tuwai, arrived to facility. LPAs continued annual inspection with director. Eating area for infants is separate from diaper changing stations. LPAs observed eating area includes age appropriate furniture with both high chairs and low tables and chairs. There is a separate kitchen preparation area in the infant classroom that is made inaccessible to children with a child safety gate. LPAs observed kitchen area to be clean and orderly. Infants' individual containers and bottles were observed to be properly labeled with infants' names. LPAs did not observe any poisons, chemicals or hazardous materials stored near kitchen preparation area. (Continue Report on Page 2...)

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2023

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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Document Has Been Signed on 10/20/2023 03:44 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 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: 10/20/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101429(a)(2)(B)

Responsibility for Providing Care and Supervision for Infants

(B) Staff shall physically check on sleeping infant(s) every 15 minutes and document the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, record review, the licensee did not comply with the section cited above. Staff did not maintain a daily sleeping log for all napping infants, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/03/2023
	Plan of Correction
1 2 3 4	Director will provide LPA proof of a staff meeting with all infant staff that discusses safe sleep regulations. Proof of staff meeting to include all staff's written signatures and sleep regulations discussed.

Type B

Section Cited

CCR

101229.1(a)(1)

Sign In and Sign Out

(a) In addition to the sign-in procedure requirement of Section 101226.1(b), the licensee shall develop, maintain and implement a written procedure to sign the child in/out of the child care center that shall, at a minimum, include the following: (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:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, record review, the licensee did not comply with the section cited above in no enrolled children were properly signed into facility with authorized representatives' written signatures, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/03/2023
	Plan of Correction
1 2 3 4	Director is aware all children must be signed into program with full legal signatures. Director will provide LPA proof of a staff meeting with all infant staff that discusses sign in/out regulations. Proof of staff meeting to include all staff's written signatures and sign in/out regulations discussed.

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: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2023

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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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: ST. NICHOLAS DAY CARE AND PRESCHOOL-INFANT	FACILITY NUMBER: 380505725
	VISIT DATE: 10/20/2023

NARRATIVE

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Sleeping area for the younger infants includes cribs that do not hinder the entrance or exit to the classroom. Cribs were free of loose articles and materials and included a tight fitting sheet. During visit, LPAs observed an infant in a crib that was placed on their back.
Infant staff utilize a sleeping log that documents the 15 minute time check of when a napping infant is checked on. LPAs reviewed sleeping logs utilized by infant staff. Upon review, LPAs did not observe a consistent daily sleeping log for napping infants. LPAs observed sleeping logs to include random days throughout the month. LPAs requested infant staff to provide sleeping log from 10/19/2023. Per staff, sleeping log was not maintained for 10/19/2023.

There is a separate room utilized for sleeping for the older infants. Cots are utilized for the older napping infants. LPAs observed cots to be appropriately stored. Sheets are stored in infants' individual cubbies. Per director, staff do not maintain sleeping logs for older infants sleeping in cots. LPAs reminded director a daily sleeping log must be maintained for all infants under 24 months.

LPAs observed poisons, cleaning solutions and poisons to be inaccessible in classrooms. Both the infant classroom and infant napping area is equipped with a carbon monoxide detector, smoke alarm system and fully charged fire extinguisher. During visit, LPAs tested both carbon monoxide detectors in classroom and sleeping room, which were observed to be working.

Infant program shares indoor atrium with preschool program on rotation schedule. LPAs observed atrium to have sufficient toys and materials that were in good condition. There are portable climbing structures with resilient padding underneath. Poles located in atrium were observed to be padded.

Licensing documents were observed to be properly posted and made available for review in the facility center and in Caterpillar classroom. Emergency drills are conducted and documented properly. Last disaster drill was conducted 08/29/2023. Children are signed into and out of program with written records. LPAs observed children to be signed in and out of program by staff and not by children's authorized representatives. LPAs reminded director children must be signed into and out of program with written legal signatures from children's authorized representative.

LPA reviewed facility records that included 5 random infants' records and 5 random staff records. LPA observed infant records to be complete. Infant records include specific infant needs and services plan as well as individual infant sleeping plan.
(Continue Report on Page 3...)

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2023

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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: ST. NICHOLAS DAY CARE AND PRESCHOOL-INFANT	FACILITY NUMBER: 380505725
	VISIT DATE: 10/20/2023

NARRATIVE

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At least 2 staff members in classroom have a current CPR/First Aid certification. Director was reminded staff who do not have any record of Early Childhood Education transcripts are not counted towards teacher to child ratio. Director was reminded Mandated Reporter training must be renewed every 2 years by all staff who work with children.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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

Director was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care
Centers (CCCs) constructed before January 1, 2010, to test their water (used for
drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.

LPA verified that the lead testing was completed in accordance to the Written Directives
outlined in PIN 21-21.1-CCP.

Facility completed lead testing December 2022. Water fixture that exceeded lead level of 5.5 ppb threshold has been remediated as of June 2023. Drinking water is made available to children with filtered water stations.

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-andresources/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.
(Continued Report on Page 4...)

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2023

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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: ST. NICHOLAS DAY CARE AND PRESCHOOL-INFANT	FACILITY NUMBER: 380505725
	VISIT DATE: 10/20/2023

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/

Director was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Program was cited 3 Type B citations for incomplete infant sleeping logs, incomplete sign in/out sheets, and lead level exceedance. Appeal Rights were provided. A plan of correction was discussed.

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

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

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/20/2023 03:44 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 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: 10/20/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

101700.3(b)(1)

California Lead Action Level at Child Care Centers (b)(1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview, record review, the licensee did not comply with the section cited above in one water fixture tested for lead exceeded 5.5 ppb threshold, which posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/20/2023
	Plan of Correction
1 2 3 4	Affected water fixutre has since been remediated as of June 2023. Affected water fixture has been replaced and retested. New lead levels show a below 5.5 ppb threshold. Deficiency cleared on this date.

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: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2023

LIC809 (FAS) - (06/04)

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