<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384000867
Report Date: 01/28/2020
Date Signed: 01/28/2020 02:20:37 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:MISSION HEAD START-WOMEN'S BUILDING CENTERFACILITY NUMBER:
384000867
ADMINISTRATOR:REYES, CINDYFACILITY TYPE:
850
ADDRESS:3543 18TH STREETTELEPHONE:
(415) 701-1995
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY:23CENSUS: 16DATE:
01/28/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Director, Cesia GomezTIME COMPLETED:
02:30 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
Licensing Program Analyst, Luis J. Gomez met with Director, Cesia Gomez. Purpose of the inspection was explained and is for an unannounced annual inspection. The preschool program is on the first floor of the the Women’s Building. Preschool program utilizes one classroom and the Indoor Gross Motor Area, located in the auditorium. Off-limits Areas: Facility Kitchen and Back Hallway. Hours of operation are Monday- Friday 8:00am- 5:30pm. Present is the Director and three staff supervising 16 children. At 11:50am on January 28, 2020, LPA Gomez observed the number of children present in day-care does not match the children sign- in log. Facility is operating within capacity limits of the license. LPA Gomez inspected facility with director for health and safety hazards.

At 11:55am on January 28, 2020, LPA inspected: Classroom, Indoor gross motor area and Kitchen. Classroom is clean, organized and have plenty of age appropriate toys, blocks, art supplies and books for the children. Classroom has several cubbies for children’s coats and belongings. There are child size tables and chairs for snack and activities. All sand tables and sensory activity stations are in good repair. For napping, the children’s cots are available inside the classroom. Per director, blankets are taken home by the parents and washed weekly. Off-limits areas are properly barricaded with the uses of child safe doors and gates. The children’s bathroom, located inside the classroom, is maintained clean with adequate supplies. Staff uses a separate restroom located in the back hallway. Accessible trash cans and outlets are covered. There is acceptable ventilation throughout. LPA Gomez observed the children’s medication is stored inaccessible to the day-care children. All children’s medication, maintained in the facility is current and properly logged. Classroom has a smoke detector, carbon monoxide detector and a fully charged fire extinguishers (2A:40BC) located next to the front door. First aid kits and emergency disaster supplies are available in the classroom.

(Continuation on 809-C)

SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2020
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 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: MISSION HEAD START-WOMEN'S BUILDING CENTER
FACILITY NUMBER: 384000867
VISIT DATE: 01/28/2020
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
(Page 2)

At 12:15pm on January 28, 2020, LPA Gomez inspected Indoor gross motor area and facility kitchen. LPA observed the Indoor gross motor area is kept clean and free of debris and hazardous items. Play equipment is in good repair and stored in the facility closet. Facility kitchen is maintained clean with facility refrigerator at the proper temperature. Refrigerator logs are updated daily. All detergents, cleaning supplies and toxins are stored inaccessible to day-care children and locked in the back closet.

During today’s inspection, four children and two personnel records were reviewed. All children files reviewed are complete. Staff CPR/ 1st aid certification is current expiring: 09/2020. Emergency drills are conducted at the facility, with the last drill done on, 10/28/2019, properly logged. Required licensing information and electronic sign-in waiver properly posted in facility. Pre director, program serves “Better 4 you" meals” for daily snacks and meals at the facility. Fresh water is readily available for children with the use of small jugs and cups.

Incidental Medical Services (IMS) was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding Americans with Disabilities Act (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: www.ada.gov/childqanda.htm.

During inspection,


· Director was reminded, as of September 1, 2016, all Staff and Volunteers must provide proof of immunization against pertussis, measles, and influenza, or qualifies for an exemption, pursuant to Health and Safety code 1596.7995 and 1597.662.
· Director was reminded about Mandated Reporter Training available on CCLD website. Training must be completed every 2 years. Training can be taken online at www.mandatedreporterca.com
(Continuation on page 3)
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2020
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: MISSION HEAD START-WOMEN'S BUILDING CENTER
FACILITY NUMBER: 384000867
VISIT DATE: 01/28/2020
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
(Page 3)
· Director was reminded about the Provider Information Notices (PINs) on CCLD website.
Licensee was advised for any additional questions to contact CCLD office, Monday to Friday, 8:00 am - 5:00 pm, (650) 266-8800 or 1 (844) 538-8766. Website: www.cdss.ca.gov

Based on today's inspection, deficiencies were observed in the areas evaluated according to the Title 22 Division 12 Ca. Code of Regulations. Exit interview and plan of correction was conducted with Cesia Gomez, and her signature of this form acknowledges receipt of these documents.



>This report and rights to comment and appeal were discussed with Cesia Gomez. This report must be available in the facility for public review. Notice of site inspection was posted.
Director 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: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2020
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: MISSION HEAD START-WOMEN'S BUILDING CENTER
FACILITY NUMBER: 384000867
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/28/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/12/2020
Section Cited

1
2
3
4
5
6
7
101229.1 Sign In Sign Out. Licensee shall develop, maintain, and implement a written procedure to sign the children in/out of the child care center. This requirement is not met as evidenced by.
8
9
10
11
12
13
14
Based on facility file review and interview with director, LPA Gomez observed that the number of children present in the day-care does not match the number of children on the facility Sign-in sheet. This poses a potential health and safety risk to children in care.
8
9
10
11
12
13
14
Director will submit proof of correction to LPA Gomez via email.

1
2
3
4
5
6
7

1
2
3
4
5
6
7
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: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 01/28/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/28/2020
LIC809 (FAS) - (06/04)
Page: 4 of 4