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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384000867
Report Date: 01/13/2022
Date Signed: 01/13/2022 02:06:18 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: 11DATE:
01/13/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Glinda RivasTIME COMPLETED:
02:15 PM
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On 1/13/2022 at 9:10A.M., Licensing Program Analyst (LPA), Luis J. Gomez met with Lead Teacher, Glenda Rivas. Purpose of the inspection was explained and was for an unannounced Annual/ Random inspection. Facility operates program on the first floor of the Women’s Building. Present was the Lead Teacher and three staff supervising 11 children. All children present are preschool age. All staff had their criminal record clearances on file. Program utilizes one classroom and indoor Auditorium. Hours of operation are: Monday- Friday 8:00am- 5:00pm. Program operates year around. LPA inspected facility with Lead Teacher for health and safety hazards.

At 9:15A.M., LPA observed the following: Classroom was clean, orderly with a variety of age-appropriate books and toys for the children. All floors and surfaces were free of obstructions. Entry way had labelled cubbies for storage of children's belongings. All accessible furniture was in good repair. Classrooms had several child sized tables and chairs for activities. Children's bathroom and all fixtures were in operating condition. (2 toilets, 5 sinks) Bathrooms had adequate supplies for the children. Staff’s restroom is located separately. For napping services, program provides cleanable cots, which are assigned to each child. Per Lead Teacher, children's napping supplies cleaned daily, blanks are washed weekly. Classroom had acceptable ventilation and proper lighting. Detergents, cleaning supplies and toxins were made inaccessible, stored in an off-limits area. All trash bins and outlets had been properly covered. Facility has a smoke detector, carbon monoxide detector and two fully charged fire extinguishers (2A:10BC) located at each end of the classroom.

At 10:00A.M., LPA inspected Indoor Auditorium/ Gross Motor Area. Auditorium was completely enclosed. Area was free of debris or hazardous items. Playthings inspected where is good repair. Per Lead Teacher, water service are provided using pitcher with disposable water cups. Off-limit areas were sealed off with movable barricades. (REFER TO 809-C FOR CONT.)

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

DATE: 01/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2022
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 5
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: 01/13/2022
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(Page 2)

At 10:15A.M., LPA review the facility records, including ten children’s files and all personnel files. Children's files reviewed were complete and included: Health History (LIC702), Identification of Emergency Information and Immunization Records. Staff files reviewed and included: Criminal Record Statements (LIC508), Declaration to Report Suspected Child Abuse (LIC9108) and Notice of Employee Rights (LIC9052).

At 10:30A.M., Based on record review, LPA confirmed staff files, S2, S3 and S4, missing the current mandated reported training certifications. Technical Violation (LIC9102TA) was issued during inspection.

At 10:35A.M. Based on record review, LPA confirmed required proof of immunization missing from the staff files. Technical Advisory (LIC9108TA) was issued during inspection.

Lead Teacher had a current CPR/ 1st aid certification, which will expires on: 7/2023. Emergency drills are conducted at the facility, with the last drill done on 12/30/2021, properly logged. Facility provides all daily snacks and meals. Updated and posted snack schedule was observed during inspection. Facility kitchen, refrigerator and food containers were reviewed during inspected. Food inspected was current and correctly stored. All required posting were posted and included the License, Parents Rights (PUB393) and Emergency Disaster Plan (LIC610). During inspection, LPA reviewed children’s medication stored at the facility.

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.)

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

DATE: 01/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2022
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: 01/13/2022
NARRATIVE
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(Page 3)

Lead Teacher 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.

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 Lead Teacher, Glinda Rivas and signature of this form acknowledges receipt of these documents.



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: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2022
LIC809 (FAS) - (06/04)
Page: 5 of 5