384000867-11-22-2022-05-CC-LGOZ-CLEREA-20221122115713

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384000867
Report Date: 11/22/2022
Date Signed: 11/22/2022 11:57:27 AM

Document Has Been Signed on 11/22/2022 11:57 AM - 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:	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: 11	DATE:	11/22/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Glenda Rivas		TIME COMPLETED:	12:15 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 11/22/2022 at 8:45AM., Licensing Program Analyst (LPA), Luis J. Gomez met with Director, Glenda Rivas. Purpose of the inspection was explained and was for an unannounced; Annual/ Random inspection. Program is located on first floor of Women’s Building. Present was the Director and two staff supervising 11 children. Staff have criminal record clearances on file. Children present had been signed-in by authorized representative. Preschool program utilizes one primary classrooms and indoor play space, Auditorium. Day and hours of operation are Monday- Friday, 8:00AM- 5:00PM. LPA inspected facility for health and safety hazards. At 8:50AM., LPA observed the following: Facility was clean, orderly, with age-appropriate playthings available for the children. Floor and ground surfaces inspected were free of obstructions. Accessible furniture and materials are maintained in proper repair, and without sharp or loose parts. Classroom is equipped with labeled cubbies for storage of belongings. Facility had several child sized tables and chairs for snack and seated activities. Children’s bathrooms had adequate supplies for hand washing. Bathroom fixtures tested (2 toilets, 5 sinks) were operating condition. For napping services, facility is equipped with stackable cots. Per director, napping supplies are washed weekly. Facility was the proper temperature, with ventilation and lighting. Detergents; cleaning supplies/ compounds; and toxins are stored in the off-limit areas. LPA reminded director to ensure all trash bins and outlets are properly covered. Classrooms had functioning carbon monoxide detector; smoke detector; and two (fully charged) fire extinguishers; 2A:10BC. Facility’s first aid kit was reviewed during inspection. (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: 11/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2022

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: MISSION HEAD START-WOMEN'S BUILDING CENTER	FACILITY NUMBER: 384000867
	VISIT DATE: 11/22/2022

NARRATIVE

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At 9:20AM., LPA inspected facility auditorium/ indoor gross motor area. Area is completely enclosed with staircases made inaccessible. Area was free of any debris or hazardous items. Play items in area are in good repair.

LPA reminded director to ensure drinking water is readily available for children at all times. Advisory Note: Technical Assistance (LIC9102TA) was issued during inspection.

Child food services, and the snack preparation area was reviewed. Food inspected was current and properly stored by staff. Area was observed clean and free of any liter or rubbish.

At 9:40AM, LPA reviewed the facility records including: five children’s and three personnel files. Staff files reviewed included the: Notice of Employee Rights (LIC9052); Criminal Record Statement (LIC508); Proof of Qualification; Required Immunization; and updated ‘Mandated Reporter Training’ Certification (AB1207).

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

Director’s ‘Cardiopulmonary Resuscitation / First Aid’ certification was current, expiring: 7/2023.
Emergency disaster drills are conducted by the facility, with last drill conducted, 10/24/2022, properly logged.

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

Children’s medication and incidental medical services (IMS) were discussed.
(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: 11/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2022

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: MISSION HEAD START-WOMEN'S BUILDING CENTER	FACILITY NUMBER: 384000867
	VISIT DATE: 11/22/2022

NARRATIVE

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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.

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

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tool, please send them to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesource/community-care-licensing/inspection-process.

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, Glenda Rivas, 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: 11/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2022

LIC809 (FAS) - (06/04)

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