384000958-10-12-2022-05-CC-LGOZ-CK5SEQ-20221012134907

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384000958
Report Date: 10/12/2022
Date Signed: 10/12/2022 01:50:22 PM

Document Has Been Signed on 10/12/2022 01:50 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:	FAMILY SCHOOL CDC BERNAL GATEWAY, THE		FACILITY NUMBER:	384000958
ADMINISTRATOR:	HAYNES, MARILYN		FACILITY TYPE:	830
ADDRESS:	3101 MISSION STREET		TELEPHONE:	(415) 550-4178
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94110
CAPACITY: 16	TOTAL ENROLLED CHILDREN: 16	CENSUS: 11	DATE:	10/12/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Patricia Bacerra		TIME COMPLETED:	02:00 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 10/12/2022 at 8:40AM., Licensing Program Analyst, Luis J. Gomez met with Staff, Karen Zepeda. Purpose of the inspection was explained and was for an Unannounced Annual/ Random inspection. Program is a Infant Center with Toddler Component. Director, Patricia Bacerra arrived during inspection. Present were and 4 staff supervising 11 children. LPA reminded director to ensure all children are signed-in by authorized representatives. Advisory Note: Technical Assistance (LIC9102TA) was issued during inspection. Staff have their criminal record clearance of file. Infant program utilizes two classrooms: Infant Room, (0- 2 years old); Toddler Room (2- 3 years old); and one outdoor play space. Shared space waiver was observed posted in facility. Hours of operation are Monday- Friday 8:00am- 5:30pm. Program operates year-round. LPA inspected facility, indoors and outdoors, for health and safety hazards. At 8:55AM., LPA observed the following: Infant and Toddler classrooms was clean, organized with age-appropriate toy and playthings available for the children. Floors and ground surfaces were free of hazards or obstructions. Infant classroom had been separated into several activity areas which include: Recreation and Napping Area. At 9:00AM., Based on observations and record review conducted, LPA confirmed infant classroom was not in proper teacher- child ratio, with no qualified teacher present. Per director, qualified infant teacher has recently resigned. Classroom had individualized storage cubbies for children’s belongings. Classrooms were equipped with diaper changing table within arm’s reach of a sink. LPA reminded director to ensure potty training chairs and children’s sink are within proximity of the outdoor activity space. Food preparation area is located separate, with a refrigerator. Children’s milk and food items inspected had been properly stored. For napping services, each infant in care had their own labeled crib/ cot. Cribs are equipped with tight-fitting sheet and proper sized mattress. Infant cribs are transparent on all sides, allowing for constant staff supervision. Per director, napping linins in cribs are changed daily, and blankets are washed weekly. (REFER TO 809C FOR CONT.)

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022

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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Document Has Been Signed on 10/12/2022 01:50 PM - It Cannot Be Edited

Created By: Luis Gomez On 10/12/2022 at 11:52 AM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: FAMILY SCHOOL CDC BERNAL GATEWAY, THE	FACILITY NUMBER: 384000958
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/12/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101429(a)(2)(C)

Responsibility for Providing Care and Supervision for Infants

(C) Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, LPA confirmed staff is not maintaining infant napping logs, documenting each 15- minute check. This poses a potential health and safety risk to children in care.
	POC Due Date: 10/21/2022
	Plan of Correction
1 2 3 4	Facility will maintain napping documentation of each 15- minute check, for all infants in care by the due date: 10/21/2022. Proof of correction will be submitted to department via email.

Type B

Section Cited

CCR

101416.5(b)

Staff-Infant Ratio

(b) There shall be a ratio of one teacher for every four infants in attendance. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observations and record review conducted, LPA confirmed infant classroom was not in proper teacher- child ratio, with no qualified teacher present. This poses a potential health and safety risk to children in care.
	POC Due Date: 10/19/2022
	Plan of Correction
1 2 3 4	Director will submit updated staff schedule by due date: 10/19/2022. Proof of correction will be submitted to the department via email.

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:

Cindy Interiano

LICENSING EVALUATOR NAME:

Luis Gomez

LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022

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: FAMILY SCHOOL CDC BERNAL GATEWAY, THE	FACILITY NUMBER: 384000958
	VISIT DATE: 10/12/2022

NARRATIVE

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Classrooms had acceptable ventilation and lighting. All trash bins, outlets have been properly covered. LPA observed accessible children's sink was in operating condition with adequate supplies. Staff restroom is located in facility hallway. Detergents; cleaning supplies; compounds and sharp objects were made inaccessible. Classroom had functioning carbon monoxide detector and a fully charged fire extinguisher (3A40:BC).

At 9:30AM., LPA inspected the outdoor play area. LPA observed area was completely enclosed. Area was clear of debris or other hazardous items. Play items and tricycles inspected were in like-new condition and play structure was properly anchored. Water service are provide with water pitcher and paper cups.

At 9:45AM., Based on observations, LPA confirmed outdoor play yard does not have shaded rest area for children in-care. Advisory Note: Technical Assistance (LIC9102TA) was issued

At 10:10AM., LPA reviewed the facility and children records. Record review included 8 children’s files and 6 personnel files. Personnel record included: ‘Mandated Reporter Training’ certification (AB1207); Notice of Employee Rights (LIC9052); Declaration to Report Suspected Child Abuse (LIC9108); and Criminal Record Statement (LIC508).

LPA reminded director to ensure staff’s proof of qualifications and required immunization’s records are stored in the facility.

Present staff member had their current Cardiopulmonary Resuscitation/ First Aid Certification on file, which expires: 6/2023.

Children files included: Infant Needs and Services Plan; Consent for Medical Treatment (LIC627); Identification of Emergency Information (LIC700); Immunization Records; Physician's Report (LIC701) and Admissions Agreement.

At 11:00AM., Based on record review, LPA confirmed children's files missing the 'Individual Infant Sleeping Plan' (LIC9227) for qualifying infants in care. Advisory Note: Technical Violation (LIC9102TV) was issued during inspection.

At 11:15AM., Based on interview and record review, LPA confirmed staff is not maintaining infant napping logs, documenting each 15- minute check.
(REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022

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: FAMILY SCHOOL CDC BERNAL GATEWAY, THE	FACILITY NUMBER: 384000958
	VISIT DATE: 10/12/2022

NARRATIVE

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Per director, emergency drills are being conducted every six months, with last drill done: 8/23/2022.

Required posting were observed in facility. Posting are properly posted in facility and include the childcare license; notification of parent’s rights; emergency disaster plan; and passenger safety laws.

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

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.

LPA discussed safe sleep regulations with the director and discussed Child Care Licensing Safe Sleep webpage at: http://www.cdss.ca.gov/inforesource/child-care-licensing/public-information-and-resouce/safe-sleep as an additional resource. LPA also informed director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at: http://www.cpsc.gov/ and recommend they register all infant devices with the CPSC to be notified of any recalls on their purchased requirement.
Based on today's inspection, deficiencies were observed in the areas evaluated according the Title 22 Division 12 Ca. Code of Regulations. Exit interview, plan of correction and report was reviewed with Director, Patricia Bacerra and signature of this form acknowledges receipt of these documents.

LPA unable to print facility evaluation report. Copy of this report will be emailed to director and physical copy will mailed to facility.

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

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022

LIC809 (FAS) - (06/04)

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