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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384000923
Report Date: 07/14/2022
Date Signed: 07/14/2022 04:29:01 PM

Document Has Been Signed on 07/14/2022 04:29 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:CHIBI-CHAN PRESCHOOLFACILITY NUMBER:
384000923
ADMINISTRATOR:KANZAKI, SHOSHANAFACILITY TYPE:
850
ADDRESS:2507 PINE STREETTELEPHONE:
(415) 351-0955
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94115
CAPACITY: 56TOTAL ENROLLED CHILDREN: 56CENSUS: 34DATE:
07/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Flora Louie, Shoshana KanzakiTIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Andrea Medlin met with facility representative, and later director, for this required annual licensing visit. Purpose of the visit explained. There are 34 children present. Teacher-child ratio is in compliance. Days and hours of operation: Monday through Friday 7:30AM-6:00PM. Physical plant toured to inspect for health and safety hazards. There are fully charged fire extinguishers that meet minimum requirements, smoke detectors, and a carbon monoxide (CO) detector in the facility. Children's bathrooms inspected; all toilets and hand washing facilities are in safe and sanitary operating condition. Separate staff bathrooms are available. No pools, spas, hot tubs, fish ponds, or similar bodies of water are present. Per staff, there are no firearms or weapons on site. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are inaccessible. Variety of age appropriate toys and materials for children are available. Classrooms are set up for child care and furniture and equipment for children is present. Mats are available for napping; facility provides napping supplies and washes once a week. Snacks are provided by the facility; parent's provide their child's lunch. Adequate first aid supplies are available. Sick children will be separated from the group while waiting for parents to pick up. Outdoor play areas inspected for health and safety hazards. The areas around and under high climbing equipment is cushioned with soft rubber. Outdoor activity spaces are enclosed by fences and surfaces are free of hazards. All the required licensing forms are posted in a prominent accessible location. LPA reviewed staff and children's files. In the children’s files, each file is complete. In the staff files, each file is complete. Staff have verification of the required staff immunization: measels (MMR) and pertussis (TDap). Staff have verification of the mandated child abuse reporting training as compliant with AB1207.


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SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Andrea Medlin
LICENSING EVALUATOR SIGNATURE: DATE: 07/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/14/2022
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: CHIBI-CHAN PRESCHOOL
FACILITY NUMBER: 384000923
VISIT DATE: 07/14/2022
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Incidental Medical Services (IMS) policy discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA is 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: http://www.ada.gov/childqanda.htm. Facility informed that effective September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.

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 tools, please send them by email 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/inforesources/community-care-licensing/process.

This report is reviewed with facility representative and a copy of this report must be made available for public review upon request.

Notice of Site Visit posted and shall remain posted for 30 days.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Andrea Medlin
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2022
LIC809 (FAS) - (06/04)
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