384000805-10-4-2022-05-CC-LGOZ-CJVQYP-20221004123529

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384000805
Report Date: 10/04/2022
Date Signed: 10/04/2022 12:35:43 PM

Document Has Been Signed on 10/04/2022 12:35 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:	FAMILY SCHOOL CHILD DEVL.CTR.-BERNAL GATEWAY, THE		FACILITY NUMBER:	384000805
ADMINISTRATOR:	BECERRA, PATRICIA		FACILITY TYPE:	850
ADDRESS:	3101 MISSION STREET		TELEPHONE:	(415) 550-4178
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94110
CAPACITY:	16	CENSUS: 9	DATE:	10/04/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:35 AM
MET WITH:	Amalia Justo, Patricia Bacerra		TIME COMPLETED:	12:45 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 10/4/2022 at 8:35AM., Licensing Program Analyst (LPA), Luis J. Gomez met with Lead Teacher, Amalia Justo. Purpose of the inspection was explained and was for an unannounced; Annual/ Random inspection. Director, Patricia Bacerra arrived during inspection. Facility is a combination center with an infant program on-site. Present was the director and two staff supervising nine children. Staff have their have criminal record clearances on file. Children present have been signed in. Preschool program utilizes one classroom and shared, Outdoor Play Area. Day and hours of operation are Monday- Friday, 8:00AM- 5:00PM. LPA inspected facility, indoors and outdoors, for health and safety hazards. At 8:55AM., LPA observed the following: Facility was clean with age-appropriate playthings available for the children. Floors and ground surfaces leading to the exits were free of obstruction. Accessible furniture and materials inspected were in good repair. Classroom is equipped with labeled cubbies and cabinets for added storage. Classroom has several child sized tables and chairs for snack and activities. Children’s bathroom has adequate supplies for hand washing. Fixtures tested were operating condition. Staff bathroom is located separate. For napping services, stackable cots are stored in facility. Per director, napping supplies are washed weekly by families. Facility has acceptable ventilation and lighting. Detergents; cleaning supplies/ compounds; and toxins are stored in the off-limit areas; Staff bathroom. Electrical outlets, heater vents, and trash bin are properly covered. Classrooms had functioning carbon monoxide detector; and one (fully charged) fire extinguishers; 2A:10BC. Facility’s first aid kit was reviewed during inspection. Facility’s food preparation room was reviewed during inspection. Food items inspected were current and properly stored. At 9:15AM., LPA inspected facility’s outdoor play area. Outdoor area is completely enclosed. Tricycles inspected were in proper repair, and area is free of debris or hazardous plants. Per director, water services are provided with water pitchers, and paper cups. Facility does not have any pools, jacuzzis fish ponds or bodies of water on site. (REFER TO 809C, FOR CONT.)

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2022

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: FAMILY SCHOOL CHILD DEVL.CTR.-BERNAL GATEWAY, THE	FACILITY NUMBER: 384000805
	VISIT DATE: 10/04/2022

NARRATIVE

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(Page 2)
At 9:45AM, LPA reviewed the facility records including seven children’s files and two personnel files. Staff files reviewed included the: Notice of Employee Rights (LIC9052); Criminal Record Statement; Mandated Reporter Training; and Declaration to Report Suspected Child Abuse (LIC9108); and Teacher Qualifications.

LPA reminded director to ensure staff's proof of required immunization are stored in the personnel files. Advisory Note: Technical Assistance (LIC9102TA) was issued.

Children’s files were reviewed and included the signed: Consent for Medical Treatment (LIC627); Identification of Emergency Information (LIC700); Health History (LIC702); Notification of Parent’s Rights (LIC995); and Physician's Report (LIC701).

Staff’s Cardiopulmonary Resuscitation / First Aid certification was current, expiring: 6/2023. Per lead teacher, emergency disaster drills are conducted, with last drill done on 8/17/2022. LPA reminded facility to document emergency disaster drill done on site.

Required forms and posted in facility: Childcare License; Child Passenger Safety Laws; Notification of Parent’s Rights (PUB394); Updated Menu (October); and Emergency Disaster Plan (LIC610).

Incident medical services (IMS) and water testing requirement was discussed with director.

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 809C FOR CONT.)

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2022

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: FAMILY SCHOOL CHILD DEVL.CTR.-BERNAL GATEWAY, THE	FACILITY NUMBER: 384000805
	VISIT DATE: 10/04/2022

NARRATIVE

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(Page 3)
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 and report was reviewed with Director, Patricia Baccera and signature of this form acknowledges receipt of these documents.

This report must be available in the facility for public review. Notice of site visit was provided and must remain posted for 30 days. Any additional questions facility was advised to call Regional Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2022

LIC809 (FAS) - (06/04)

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