380506510-12-20-2021-05-CC-HKAR-C9VUR6-20211220144813

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 380506510
Report Date: 12/20/2021
Date Signed: 12/20/2021 02:48:21 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:	HELEN HAWK CHILDREN'S CTR-COMPASS FAM. SRVS.-SA		FACILITY NUMBER:	380506510
ADMINISTRATOR:	ELIZABETH PERLA		FACILITY TYPE:	840
ADDRESS:	111 PAGE STREET		TELEPHONE:	(415) 644-0504
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94102
CAPACITY:	5	CENSUS: 0	DATE:	12/20/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Elizabeth Perla		TIME COMPLETED:	04:00 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	Licensing Program Analyst (LPA) Kaur met with site supervisor, Elizabeth Perla, for a random annual inspection. Purpose of the inspection was explained. Present, there are no children. Facility operate school age program day care from Monday to Friday between 04:00 PM to 06:00 PM With site supervisor, LPA inspected the day care classroom and play yard. There are no pools, spas or other bodies of water at the facility. Facility has multiple smoke detectors, carbon monoxide detectors and fully charged fire extinguishers on site. Facility has working telephone at the site. All of the cleaning solutions, poisons and other chemicals that are dangerous to the children are stored in high cabinets and are inaccessible to the children. Facility has age appropriate furniture. Furniture is steady and in good repair. All toilets, hand washing facilities are in working condition with proper sanitation in place. Facility has drinking water available for children. School age children have different types of activity schedule. Facility has first aid supplies available at the multiple locations. Per site supervisor, facility only provides snacks, but no meals. All of the unused electrical outlets have child protective covers installed. There is drinking water in play yard for children. Play yard is free of hazards. All of the play structures are steady, in good repair and free of any loose parts. There is sufficient amount of shaded area available for children to use. The last fire drill was conducted on 12/09/2021 See next page for continuation .............

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Harsimran Kaur	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 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: HELEN HAWK CHILDREN'S CTR-COMPASS FAM. SRVS.-SA	FACILITY NUMBER: 380506510
	VISIT DATE: 12/20/2021

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
26
27
28
29
30
31
32

LPA inspected the outdoor play area. LPA observed outdoor play area is completely enclosed with tall fencing. Outdoor play area is kept clean, free of debris and hazardous items. Play structure and shaded rest area was properly anchored. Toddler/ Preschool activity schedule was provided during inspection. Per director, water service is provided inside and outside with large refillable containers.

LPA review facility records including 3 children’s files and 1 personnel files. Children files reviewed are complete and included: Consent for Medical Treatment (LIC627), Identification of Emergency Information (LIC700), Immunization Records and Admissions Agreement. Staff files included: Health Screening (LIC503), Declaration to Report Suspected Child Abuse (LIC9108) and notice of Employee Rights (LIC9052)

LPA reminded director to have proof of Immunization on files for all staff. Present staff members had their current CPR/ 1^st aid certification which expires: 01/2023. Emergency drills are conducted at the facility, with the last drill done on 12/09/2021, properly logged. Per Director, parents provide all meals for day-care children. Facility provides snack. Snack schedule was observed during inspection. Required posting was observed in the facility entry way including: License, Parents Rights (PUB393), Emergency Disaster Plan (LIC610) and LIC613A.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manuel – Regulations Interpretations and Procedures for Child Care Centers Section 101173 and 101226. When an IMS is provided, an updated Plan of Operations that includes IMS must be submitted to the Department. Following information regarding ADA was provided: US Department of Justice (USDOJ) toll- free ADA information line at (800) 514- 0382 (TTY) and link to publications: Commonly asked questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

(REFER TO 809-C FOR CONT.)

(Page 3)

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Harsimran Kaur	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2021

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: HELEN HAWK CHILDREN'S CTR-COMPASS FAM. SRVS.-SA	FACILITY NUMBER: 380506510
	VISIT DATE: 12/20/2021

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
26
27
28
29
30
31
32

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 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.

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

Based on today's inspection, no deficiencies were observed in the areas evaluated according the Title 22 Division 12 Ca. Code of Regulations. Exit interview was discussed with Director, Elizabeth Perla and her signature of this form acknowledges receipt of these documents. Reports will be emailed to Eperla@compass-sf.org.

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

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Harsimran Kaur	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2021

LIC809 (FAS) - (06/04)

Page: 3 of 3