384000867-2-28-2024-05-CC-LGOZ-D2VS9K-20240228124052

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384000867
Report Date: 02/28/2024
Date Signed: 02/28/2024 12:41:01 PM

Document Has Been Signed on 02/28/2024 12:41 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	MISSION HEAD START-WOMEN'S BUILDING CENTER		FACILITY NUMBER:	384000867
ADMINISTRATOR:	REYES, CINDY		FACILITY TYPE:	850
ADDRESS:	3543 18TH STREET		TELEPHONE:	(415) 701-1995
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94110
CAPACITY:	23	CENSUS: 13	DATE:	02/28/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Maria Rodriguez, Theresa Sanchez		TIME COMPLETED:	12:50 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 2/28/2024 at 9:00AM., Licensing Program Analyst (LPA), Luis Gomez and Lead Teacher, Maria Rodriguez. The purpose of the inspection was explained and was for an Unannounced, Annual Random inspection. Facility is licensed to operate a preschool program inside the Women’s Building. Per lead teacher, site director is not present today. Regional Manager, Theresa Sanchez arrived during inspection. Present was the Regional Manager and 5 staff supervising 13 children. The children present had been properly signed in by authorized representee. The Department has obtained staff's criminal record clearances of file. The childcare program utilizes one classroom, and the indoor auditorium/ gross motor room. LPA inspected this facility for health and safety hazards. At 9:10AM., LPA observed the following: Classroom was clean, with age-appropriate materials available for the children. Floor and ground surfaces were clear of obstructions or possible hazards. The classroom was equipped with tables and chairs, scaled to the size of the children. Children's cubbies/ individual storage, available in the entry way. Accessible furniture inspected was free of any sharp corners or splinters. The children’s bathrooms were clean, with toilets (2) and hand washing fixtures (5) in operating condition. Per Regional Manager, the staff bathroom is located separately. For scheduled rest/ nap services, classroom had stackable cots made of a cleanable material. Per Regional Manager, napping linens and blankets are washed by staff every week. The facility had adequate ventilation, lighting, and was a comfortable temperature. All disinfectants, cleaning solutions, poisons and other items that could pose a danger, have been stored in the off-limit areas. Facility had a smoke detector; carbon monoxide detector; telephone service; and fire extinguishers: 2A:10:BC, fully charged. (REFER TO 809c, FOR CONT.)

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024

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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: MISSION HEAD START-WOMEN'S BUILDING CENTER	FACILITY NUMBER: 384000867
	VISIT DATE: 02/28/2024

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 9:50AM., LPA inspected Indoor, Gross Motor Area. Area was completely enclosed with staircase made inaccessible with safety gates. Children’s playthings and equipment inspected were in good repair. Per Regional Manager, water services are provided with refillable cups.

Facility’s food preparation area/ food storage was reviewed during inspection. Program provides two snack and lunch daily, delivered by third-party service. The food preparation area was observed clean and free of any trash or rubbish. Prepared food items inspected were current and had been properly stored.

At 10:10AM., LPA reviewed facility records including: 5 children’s files and 5 personnel files. The personnel files were reviewed and contained: Teachers Qualifications; Notice of Employee Rights (LIC9052); Acknowledgement to Report Suspected Child Abuse (LIC9108); and Personnel Record.

LPA reminded facility to ensure all staff complete the 'Mandated Reporter Training Certification' (AB1207). Facility was issued Advisory Note, Technical Violation (LIC9102TV) during inspection.

Facility’s children’s files were reviewed and contained the: Immunization Records, Identification and Emergency Information (LIC700); Notification of Parent’s Rights (LIC995); Consent for Emergency Medical Treatment (LIC627); and Personal Rights (LIC613A).

Facility personnel have Cardiopulmonary Resuscitation / First Aid certifications, set to expire on: 7/2025.

The required emergency disaster drills are being conducted every six months, with last drill completed on 1/19/2024, properly logged.

LPA advised the regional manager to ensure when change of director has occurred, to contact the Department within 10 days. Facility was issued Advisory Note, Technical Violation (LIC9102TV) during inspection.

LPA observed required postings in classroom, included the: License; Notification of Parent’s Rights (PUB394); Passenger Safety Laws (PUB269); Snack Menu (February); Result of Water Lead Testing; Gross Motor Space Waiver; and Emergency Disaster Plan (LIC610). (REFER TO 809c, FOR CONT.)

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024

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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: MISSION HEAD START-WOMEN'S BUILDING CENTER	FACILITY NUMBER: 384000867
	VISIT DATE: 02/28/2024

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)
Assembly Bill (AB) 2370, chapter 676, statues 2018 requires all licensed child care centers (CCC’s) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and every five years after the date of the first test.

LPA verified that the lead testing was completed in accordance to Written Directives outlined in PIN 21-21- CCP.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Regional Manager was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website athttps://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

Based on today's inspection, no deficiencies were cited in the areas evaluated according to the Title 22 Division 12 Chap. 1 Ca. Code of Regulations. Exit interview and facility evaluation report was discussed with Regional Manager, Theresa Sanchez. Administrator’s signature on this form acknowledges receipt of these documents.

This report must be made available in the facility for public review. Notice of site visit was given and must remain posted for 30 days. The Regional Manager was advised, any additional questions/ concerns to contact the office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024

LIC809 (FAS) - (06/04)

Page: 5 of 5