380506430-9-12-2022-05-CC-CQUO-CJ7SJ4-20220912135428

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 380506430
Report Date: 09/12/2022
Date Signed: 09/12/2022 01:54:41 PM

Document Has Been Signed on 09/12/2022 01:54 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:	ST. PAUL'S CHURCH-LITTLEST ANGEL PREPARATORY PRESC		FACILITY NUMBER:	380506430
ADMINISTRATOR:	BALUYUT, MA CONCEPCION		FACILITY TYPE:	850
ADDRESS:	221 VALLEY STREET, ROOM X		TELEPHONE:	(415) 824-5437
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94131
CAPACITY:	38	CENSUS: 18	DATE:	09/12/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Concepcion "Tina" Baluyut		TIME COMPLETED:	02:00 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 September 12, 2022 at approximately 8:30am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, annual inspection. LPA met with director, Concepcion "Tina" Baluyut, and explained the purpose of the inspection. Present during inspection included 18 children (preschool age) and 5 staff members (including director). Facility is operating within capacity requirements and ratios at time of LPA's inspection. Hours of operation are Monday to Friday, 8:00am to 5:00pm. With director, LPA inspected facility, indoors and outdoors, for health and safety hazards. Facility is a single level facility that includes one large classroom, separated into different sections. Classroom sections include areas for dramatic play, arts and crafts and story/circle time. LPA observed classroom to be clean, equipped with age appropriate toys, materials and furniture. Storage for children's belongings are located inside the classroom, labeled with each child's individual names. LPA observed classroom has multiple carbon monoxide detectors, smoke detectors, fully charged fire extinguishers, fully stocked first aid kits and fully stocked emergency backpacks with supportive documentation. Required licensing posters and documentation are properly posted in doorway of facility, available for review. All poisons, cleaning solutions and hazardous materials are stored inaccessible to children on facility's high shelves or off limit teacher office/lounge. LPA observed bathrooms used for day care are clean and in proper working condition. Bathroom is equipped with 3 toilet stalls and 3 sinks. Children's sinks do not provide water that is warmer than 120 degrees Fahrenheit. Facility does not currently provide a food service. Children's authorized representatives provide children their food in individually packed lunch bags. Lunch bags are properly labeled and stored. Water is available to children indoors and outdoors with children's water bottles, labeled with child's individual names and/or water pitchers with disposable cups. (Continue Report on Page 2...)

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2022

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. PAUL'S CHURCH-LITTLEST ANGEL PREPARATORY PRESC	FACILITY NUMBER: 380506430
	VISIT DATE: 09/12/2022

NARRATIVE

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Outdoor area was observed to be equipped with age appropriate materials that were in good working condition. Program has outdoor play area that is adjacent to preschool. Program also has shared use of elementary school's playground and gymnasium. LPA observed elementary school playground and gymnasium to be clean and properly maintained. Per director, preschool program provides children with play equipment on a mobile cart that is brought to and from preschool classroom. Director is aware preschool children are not to co-mingle with elementary school children, and must always be supervised.

Children are signed in and out of facility by their authorized representatives' electronic signatures. During LPA's visit, all children were properly signed in to program.

LPA reviewed facility records that included 10 children's records, 5 staff records (whom were present during inspection). LPA observed children's and staff's records to be complete. Multiple staff members on site have a valid, CPR certificate that will expire 06/2023. Due to school year beginning 09/06/2022, emergency drill has not yet been conducted. Next emergency drill is scheduled for 10/07/2022. Director is aware emergency drills are to be conducted at least once every six months and 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 completed certificates on file. LPA encourages the director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates.

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.

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SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2022

LIC809 (FAS) - (06/04)

Page: 2 of 3

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. PAUL'S CHURCH-LITTLEST ANGEL PREPARATORY PRESC	FACILITY NUMBER: 380506430
	VISIT DATE: 09/12/2022

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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.

Incidental Medical Services (IMS) policy was discussed. 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

No deficiencies were issued under CCR, Title 22, Division 12.

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

Exit interview conducted and report was reviewed with director, Concepcion "Tina" Baluyut.

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2022

LIC809 (FAS) - (06/04)

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